Provider Demographics
NPI:1679253967
Name:WHITE, JEREMY (RBT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6723 SILENT VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-8656
Mailing Address - Country:US
Mailing Address - Phone:571-946-0584
Mailing Address - Fax:
Practice Address - Street 1:8270 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1219
Practice Address - Country:US
Practice Address - Phone:702-350-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician