Provider Demographics
NPI:1396561288
Name:KAVANAUGH, CIAN (RBT)
Entity type:Individual
Prefix:
First Name:CIAN
Middle Name:
Last Name:KAVANAUGH
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7880 W MAULE AVE UNIT 1070
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-5382
Mailing Address - Country:US
Mailing Address - Phone:725-254-8037
Mailing Address - Fax:
Practice Address - Street 1:7880 W MAULE AVE UNIT 1070
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-5382
Practice Address - Country:US
Practice Address - Phone:725-254-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT4578106S00000X
NVRBT-24-376658106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician