Keith Addison
Individual provider Active NPI Behavior Analyst · Las Vegas, NV
NPI 1770083552 · NPPES record last updated Feb 18, 2018
Key facts
- NPI
- 1770083552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- Practice address
- 7473 W Lake Mead Blvd # 205
Las Vegas, NV 89128-0265 - Phone
- (702) 562-1294
- NPI assigned
- Feb 18, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Yes |
Addresses
Primary practice location
7473 W Lake Mead Blvd # 205
Las Vegas, NV 89128-0265
Mailing address
6103 Sundown Crest St
Las Vegas, NV 89113-6602
Phone (702) 364-4694
Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.