Provider Demographics
NPI:1497268791
Name:LEYTHAM, PATRICK ALLEN (PHD, BCBA, LBA)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ALLEN
Last Name:LEYTHAM
Suffix:
Gender:M
Credentials:PHD, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8072 W SAHARA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1974
Mailing Address - Country:US
Mailing Address - Phone:725-205-3628
Mailing Address - Fax:702-552-2449
Practice Address - Street 1:8072 W SAHARA AVE STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1974
Practice Address - Country:US
Practice Address - Phone:725-205-3628
Practice Address - Fax:702-552-2449
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-19-36091103K00000X, 103K00000X
NVLBA0253103K00000X
NVLBAT1009103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250021139Medicaid