Individual
BREONDA T JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3435 W CRAIG RD STE B, NORTH LAS VEGAS, NV 89032-5116
(702) 207-4457
Mailing address
3157 N RAINBOW BLVD # 182, LAS VEGAS, NV 89108-4578
(720) 366-9683
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
NV
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1702520941
—
NV
Enumeration date
01/03/2018
Last updated
01/03/2018
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