MEDICARE: LIGHTSHIP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1518752385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTSHIP LLC

Provider Business Mailing Address
First Line	:	7633 CALICO FIELDS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7633 CALICO FIELDS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0433
Country	:	US
Telephone Number	:	702-917-7369
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	CECILIA DURAN
Credential	:
Telephone Number	:	702-917-7369

Provider Enumeration Date	:	04/11/2025
Last Update Date	:	04/12/2025

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Directions to “LIGHTSHIP LLC ” Practice Location

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