Provider Demographics
NPI:1700175098
Name:ARCHIE, JAMES A JR
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:ARCHIE
Suffix:JR
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 1:7100 W ALEXANDER RD
Mailing Address - Street 2:APT 2100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6596
Mailing Address - Country:US
Mailing Address - Phone:702-764-2193
Mailing Address - Fax:
Practice Address - Street 1:7100 W ALEXANDER RD
Practice Address - Street 2:APT 2100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6596
Practice Address - Country:US
Practice Address - Phone:702-764-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1114236205Medicaid