Basic Information
| Provider Information | |||||||||
| NPI: | 1548983760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APPLIED BEHAVIOR ANALYSIS INSTITUTE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 408 S JONES BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891072658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025028021 | ||||||||
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| Address1: | 408 S JONES BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891072658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025028021 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2022 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | GARDNER | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | LICENSED PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7252258107 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | APPLIED BEHAVIOR ANALYSIS INSTITUTE, INC. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 1780815191 | 01 | NV | NPI | OTHER |