MEDICARE: DREAMING OUT LOUD 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
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568117687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAMING OUT LOUD LLC

Provider Business Mailing Address
First Line	:	1000 WIGWAM PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8164
Country	:	US
Telephone Number	:	702-476-4286
Fax Number	:	702-476-4211

Provider Business Practice Location Address
First Line	:	1000 WIGWAM PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8164
Country	:	US
Telephone Number	:	702-476-4286
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BRIANA HECTOR
Credential	:
Telephone Number	:	702-476-4286

Provider Enumeration Date	:	02/17/2022
Last Update Date	:	09/23/2024

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