Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 55164 | NV |
N | 106S00000X | Behavior Technician |
NPI | 1174068514 |
---|---|
Provider Name | Mr. Robert Carter JR. |
First Address | Henderson, NV 89002-8274 |
Second Address | Henderson, NV 89002-8274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2016 |
Last Update Date | 20/12/2016 |