Provider Demographics
NPI:1437665742
Name:KANG, MARIEL ANJELINE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MARIEL ANJELINE
Middle Name:
Last Name:KANG
Suffix:
Gender:F
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 1:7260 W AZURE DR STE 140-44
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-7999
Mailing Address - Country:US
Mailing Address - Phone:702-789-7282
Mailing Address - Fax:
Practice Address - Street 1:7260 W AZURE DR STE 140-44
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-7999
Practice Address - Country:US
Practice Address - Phone:702-789-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15-10904106S00000X
NVLBA0820103K00000X
CA1-22-61537103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician