| Provident Place | |
|
611 Seneca Ridge Ave N Las Vegas NV 89084-1315 | |
| (702) 561-3408 | |
| Not Available |
| Full Name | Provident Place |
|---|---|
| Speciality | Behavior Analyst |
| Location | 611 Seneca Ridge Ave, N Las Vegas, Nevada |
| Authorized Official Name and Position | Katie Smith (OWNER) |
| Authorized Official Contact | 7025613408 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provident Place 611 Seneca Ridge Ave N Las Vegas NV 89084-1315 Ph: (702) 561-3408 | Provident Place 611 Seneca Ridge Ave N Las Vegas NV 89084-1315 Ph: (702) 561-3408 |
| NPI Number | 1760049621 |
|---|---|
| Provider Enumeration Date | 05/24/2019 |
| Last Update Date | 05/24/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760049621 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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