Provider Demographics
NPI:1376872333
Name:SUMMERS, JAMES (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 PAINTED MIRAGE RD STE 320-A105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4581
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6628 SKY POINTE DR
Practice Address - Street 2:SUITE 114
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4070
Practice Address - Country:US
Practice Address - Phone:702-704-5112
Practice Address - Fax:866-633-9254
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0045251S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1295157287Medicaid