Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | LABA0321 | NV |
N | 106S00000X | Behavior Technician |
NPI | 1114470531 |
---|---|
Provider Name | Kelly Demos |
First Address | Las Vegas, NV 89129-8307 |
Second Address | Las Vegas, NV 89107-2658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2016 |
Last Update Date | 24/07/2020 |