Provider Demographics
NPI:1497168744
Name:SOUTHWEST AUTISM & BEHAVIORAL SOLUTIONS
Entity Type:Organization
Organization Name:SOUTHWEST AUTISM & BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FESSENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D
Authorized Official - Phone:702-499-7502
Mailing Address - Street 1:2700 E SUNSET RD
Mailing Address - Street 2:24
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3506
Mailing Address - Country:US
Mailing Address - Phone:702-270-3219
Mailing Address - Fax:
Practice Address - Street 1:2700 E SUNSET RD
Practice Address - Street 2:24
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3506
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:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV04072014103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV04072014OtherCABI