Individual
AMANDA SOUTHWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6330 MCLEOD DR STE 3, LAS VEGAS, NV 89120-4431
(702) 487-5480
Mailing address
2020 PINTO LN, LAS VEGAS, NV 89106-4019
(702) 868-2901
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DO9097297
—
AZ
Enumeration date
06/14/2018
Last updated
06/18/2019
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