Provider Demographics
NPI:1881001659
Name:NICHOLAS TAYLOR
Entity Type:Organization
Organization Name:NICHOLAS TAYLOR
Other - Org Name:BASIC BEHAVIORAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-203-3867
Mailing Address - Street 1:5111 CASPIAN SPRINGS DR. #204
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120
Mailing Address - Country:US
Mailing Address - Phone:702-203-3867
Mailing Address - Fax:
Practice Address - Street 1:5111 CASPIAN SPRINGS DR APT 204
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-1155
Practice Address - Country:US
Practice Address - Phone:702-203-3867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health