Provider Demographics
NPI:1184170680
Name:MCCAULEY, JELLY MAE (RBT)
Entity type:Individual
Prefix:
First Name:JELLY MAE
Middle Name:
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:JELLY MAE
Other - Middle Name:FAMI
Other - Last Name:SALVACION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:429 DON PEDRO CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2835
Mailing Address - Country:US
Mailing Address - Phone:702-768-3827
Mailing Address - Fax:
Practice Address - Street 1:429 DON PEDRO CIR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2835
Practice Address - Country:US
Practice Address - Phone:702-768-3827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT 15-08788103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst