Provider Demographics
NPI:1336464460
Name:SOUTHWEST AUTISM & BEHAVIORAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SOUTHWEST AUTISM & BEHAVIORAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FESSENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-270-3219
Mailing Address - Street 1:2110 E FLAMINGO RD STE 350
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5190
Mailing Address - Country:US
Mailing Address - Phone:702-270-3219
Mailing Address - Fax:866-833-2056
Practice Address - Street 1:2110 E FLAMINGO RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5190
Practice Address - Country:US
Practice Address - Phone:702-270-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty