Provider Demographics
NPI:1518404094
Name:VANVOORHIS, KRYSTAL (BCBA)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:VANVOORHIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 VILLAGE WALK DR
Mailing Address - Street 2:4303
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5734
Mailing Address - Country:US
Mailing Address - Phone:951-905-8652
Mailing Address - Fax:
Practice Address - Street 1:2151 VILLAGE WALK DR
Practice Address - Street 2:4303
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5734
Practice Address - Country:US
Practice Address - Phone:951-905-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-22425103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst