Provider Demographics
NPI:1245710946
Name:LIM, MATTHEW NIKOA
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:NIKOA
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 E HACIENDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2819
Mailing Address - Country:US
Mailing Address - Phone:702-487-2905
Mailing Address - Fax:
Practice Address - Street 1:3620 N RANCHO DR STE 117
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3154
Practice Address - Country:US
Practice Address - Phone:702-655-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst