Provider Demographics
NPI:1841800554
Name:RESET BEHAVIOR LLC
Entity Type:Organization
Organization Name:RESET BEHAVIOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-339-5565
Mailing Address - Street 1:6471 AMERICAN EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3252
Mailing Address - Country:US
Mailing Address - Phone:702-339-5565
Mailing Address - Fax:
Practice Address - Street 1:6471 AMERICAN EAGLE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-3252
Practice Address - Country:US
Practice Address - Phone:702-339-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty