MEDICARE: KATELYN TERRY

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	1-26-89030	NV

General Provider Information

NPI Number	:	1619660792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN TERRY

Provider Business Mailing Address
First Line	:	6836 DIABLO RIM ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89086-1619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 W HORIZON RIDGE PKWY STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4395
Country	:	US
Telephone Number	:	702-781-0011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	04/17/2026

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Directions to “ KATELYN TERRY ” Practice Location

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