Individual
GLEN ETHAN GILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
630 S RANCHO DR, LAS VEGAS, NV 89106-4873
(702) 780-2315
(702) 527-7939
Mailing address
5450 S FORT APACHE RD APT 202, LAS VEGAS, NV 89148-4691
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
04/02/2018
Last updated
02/24/2020
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