Provider Demographics
NPI:1760678783
Name:KYRIANNIS, JUSTIN N (MA, BCBA,LBA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:N
Last Name:KYRIANNIS
Suffix:
Gender:M
Credentials:MA, BCBA,LBA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9167 W FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6472
Mailing Address - Country:US
Mailing Address - Phone:702-565-1894
Mailing Address - Fax:702-565-0056
Practice Address - Street 1:9167 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147
Practice Address - Country:US
Practice Address - Phone:702-565-1894
Practice Address - Fax:702-565-0056
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLBA143103K00000X
TNBCBA 1-02-0938103K00000X
NVLBA0029103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst