Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 103K00000X | Behavior Analyst |
NPI | 1013312719 |
---|---|
Provider Name | Cindy Lou Limburg |
First Address | Las Vegas, NV 89130-2811 |
Second Address | Las Vegas, NV 89130-2811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2014 |
Last Update Date | 17/12/2014 |