Individual
GAVIN LANELL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7720 COWBOY TRL, LAS VEGAS, NV 89131-2131
(702) 510-3790
Mailing address
7720 COWBOY TRAIL, LAS VEGAS, NV 89131
(702) 510-3790
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164669479
—
NV
Enumeration date
03/25/2013
Last updated
03/25/2013
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