Basic Information
| Provider Information | |||||||||
| NPI: | 1194262592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | LATAVIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1926 HELEN AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890323744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026095087 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2110 E FLAMINGO RD # 150 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891195190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022703219 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2017 | ||||||||
| LastUpdateDate: | 01/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 362214 | NV | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.