MEDICARE: NEVADA ABA THERAPY PROF 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	:	1578277042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA ABA THERAPY PROF LLC

Provider Business Mailing Address
First Line	:	9024 MISTY LEAF AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5147
Country	:	US
Telephone Number	:	949-413-3756
Fax Number	:

Provider Business Practice Location Address
First Line	:	9024 MISTY LEAF AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5147
Country	:	US
Telephone Number	:	949-413-3756
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARIAM NAWABI
Credential	:	MA, LBA, BCBA
Telephone Number	:	949-413-3756

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

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Directions to “NEVADA ABA THERAPY PROF LLC ” Practice Location

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