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NPI Code Detail

MEDICARE: TYRONE COOLEY QBA

MEDICARE: TYRONE COOLEY QBA
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649575358
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRONE COOLEY QBA
Provider Business Mailing Address
First Line : 1350 E FLAMINGO RD
Second Line : BOX 577
City : LAS VEGAS
State : NV
Zip : 89119-5263
Country : US
Telephone Number : 702-834-5849
Fax Number : 702-483-6288
Provider Business Practice Location Address
First Line : 3430 E FLAMINGO RD
Second Line : SUITE 237
City : LAS VEGAS
State : NV
Zip : 89121-5003
Country : US
Telephone Number : 702-834-5849
Fax Number : 702-483-6288
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2011
Last Update Date : 01/11/2011

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Directions to “ TYRONE COOLEY QBA” Practice Location

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