Individual
MR. LOGAN JAMES GOOLSBY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, BA
Contact information
Practice address
3365 WYNN RD, LAS VEGAS, NV 89102-8210
(702) 331-3845
Mailing address
2408 MOUNTAIN RAIL DR, NORTH LAS VEGAS, NV 89084-3128
(951) 285-0893
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
NV
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103K00000X
—
NV
Enumeration date
01/02/2020
Last updated
01/02/2020
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