Individual
RAY TRAVIS GOODIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2625 WYANDOTTE ST, # 17, LAS VEGAS, NV 89102-6471
(313) 433-7330
Mailing address
2625 WYANDOTTE ST, # 17, LAS VEGAS, NV 89102-6471
(313) 433-7330
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/19/2016
Last updated
10/07/2016
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