Provider Demographics
NPI:1295157287
Name:PUZZLE PIECES AUTISM AND BEHAVIORAL SERVICES, LLC
Entity type:Organization
Organization Name:PUZZLE PIECES AUTISM AND BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:I
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:702-818-1702
Mailing Address - Street 1:5550 PAINTED MIRAGE RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4581
Mailing Address - Country:US
Mailing Address - Phone:702-818-1702
Mailing Address - Fax:
Practice Address - Street 1:5550 PAINTED MIRAGE RD
Practice Address - Street 2:SUITE 320
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4581
Practice Address - Country:US
Practice Address - Phone:702-818-1702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141004089251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health