Club Social, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

CLUB SOCIAL, LLC

Practice address

1070 W Horizon Ridge Pkwy Ste 200
Henderson, NV 89012-6019

Phone

(702) 686-2698

NPI assigned

Aug 28, 2024

Last updated

Aug 28, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ellie Brim, BCBANPI 1326870593

Title

Owner

Phone

(702) 686-2698

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ellie Brim, BCBA

  • Behavior Analyst
  • Henderson, NV
  • NPI 1326870593
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1811721392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 W HORIZON RIDGE PKWY STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890126019",
            "telephone_number": "702-686-2698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 W HORIZON RIDGE PKWY STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890126019",
            "telephone_number": "702-686-2698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB SOCIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "BRIM",
        "authorized_official_first_name": "ELLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-686-2698",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Henderson, NV
• Providers in Henderson, NV by specialty
• Behavior Analyst in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.