Provider Demographics
NPI:1639694375
Name:SIMPLE BEHAVIOR SOLUTIONS
Entity Type:Organization
Organization Name:SIMPLE BEHAVIOR SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN VOORHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:951-905-8652
Mailing Address - Street 1:2151 VILLAGE WALK DR
Mailing Address - Street 2:
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:
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:951-905-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBA00106103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1518404094Medicaid