Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 103TH0100X | Health Service |
NPI | 1346682366 |
---|---|
Provider Name | Reavous J Thomas |
First Address | Las Vegas, NV 89106-4314 |
Second Address | Las Vegas, NV 89106-4314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2013 |
Last Update Date | 18/07/2013 |