Active NPI
Sierra Van Laethem, RBT
- Behavior Technician
- Mesa, AZ
National Provider Identifier
1811506595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 20118367
- Practice address
- 2266 S Dobson Rd Ste 200
Mesa, AZ 85202-6412 - Phone
- (480) 757-8090
- NPI assigned
- Jul 28, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 20118367 | AZ | Primary |
Addresses
Primary practice location
2266 S Dobson Rd Ste 200
Mesa, AZ 85202-6412
Mailing address
PO Box 258831
Oklahoma City, OK 73125-8831
Phone (720) 961-3764
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20118367 | Other | AZ | RBT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20118367 | AZ | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595894400000",
"number": "1811506595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 258831",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731258831",
"telephone_number": "720-961-3764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2266 S DOBSON RD STE 200",
"city": "MESA",
"state": "AZ",
"postal_code": "852026412",
"telephone_number": "480-757-8090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN LAETHEM",
"first_name": "SIERRA",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-28",
"last_updated": "2020-07-28",
"certification_date": "2020-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "AZ",
"license": "20118367",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RBT",
"identifier": "20118367",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.