Provider Demographics
NPI:1376298364
Name:BROWN, BRUCE EDWARD (RBT, LBT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:EDWARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:RBT, LBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S RANCHO DR STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4849
Mailing Address - Country:US
Mailing Address - Phone:702-844-4579
Mailing Address - Fax:702-527-7939
Practice Address - Street 1:630 S RANCHO DR STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4849
Practice Address - Country:US
Practice Address - Phone:702-998-9505
Practice Address - Fax:702-527-4579
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-191694106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician