Individual
SHANESE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
605 E LA MADRE WAY, NORTH LAS VEGAS, NV 89081-3095
(702) 633-5766
Mailing address
605 E LA MADRE WAY, NORTH LAS VEGAS, NV 89081-3095
(702) 633-5766
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NV20141206935
—
NV
Enumeration date
05/12/2014
Last updated
05/12/2014
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