Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst |
NPI | 1003177973 |
---|---|
Provider Name | Kim L Green |
First Address | North Las Vegas, NV 89032-8260 |
Second Address | Las Vegas, NV 89120-4431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2012 |
Last Update Date | 27/06/2019 |