Individual
MR. JOHN WILLIAM PHILLIPS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
408 S JONES BLVD, LAS VEGAS, NV 89107-2658
(702) 502-8021
Mailing address
220 PAUL AVE, LAS VEGAS, NV 89106-2740
(725) 203-0007
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00001749386
—
NV
Enumeration date
02/11/2019
Last updated
02/11/2019
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