Provider Demographics
NPI:1881261055
Name:ROBINSON, TIA MONIQUE (RBT)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:MONIQUE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 S FORT APACHE RD APT 2025
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5755
Mailing Address - Country:US
Mailing Address - Phone:702-808-0647
Mailing Address - Fax:
Practice Address - Street 1:3811 W CHARLESTON BLVD STE 111
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1846
Practice Address - Country:US
Practice Address - Phone:702-762-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2106680955106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician