Provider Demographics
NPI:1184149874
Name:SIMPLE BEHAVIOR SOLUTIONS LLC
Entity type:Organization
Organization Name:SIMPLE BEHAVIOR SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN VOORHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:702-762-5305
Mailing Address - Street 1:12020 SOUTHERN HIGHLANDS PKWY APT 1245
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3012
Mailing Address - Country:US
Mailing Address - Phone:702-762-5305
Mailing Address - Fax:
Practice Address - Street 1:8565 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2906
Practice Address - Country:US
Practice Address - Phone:702-762-5305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1518404094Medicaid