Provider Demographics
NPI:1790354397
Name:NELSON, LAURA KIRSTEN (RBT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KIRSTEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 GOLDEN SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-8619
Mailing Address - Country:US
Mailing Address - Phone:702-715-1939
Mailing Address - Fax:
Practice Address - Street 1:7181 N HUALAPAI WAY STE 975
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-1115
Practice Address - Country:US
Practice Address - Phone:877-712-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-21-172511106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician