Provider Demographics
NPI:1558148254
Name:UNBOUND ABA
Entity Type:Organization
Organization Name:UNBOUND ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAJON
Authorized Official - Middle Name:KENTRELL
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:916-504-7199
Mailing Address - Street 1:304 S JONES BLVD # 1371
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:916-504-7199
Mailing Address - Fax:
Practice Address - Street 1:4008 JUANITA MAY AVE,
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8949
Practice Address - Country:US
Practice Address - Phone:916-504-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty