Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013322072 |
---|---|
Provider Name | Allen Lamar Swinson JR. |
First Address | Las Vegas, NV 89106 |
Second Address | Las Vegas, NV 89117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2014 |
Last Update Date | 27/06/2014 |