Organization
KIMBERLY BROUSSARD
Active
Other names
PHENOMENAL ANGELS
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY RASHONE BROUSSARD (OWNER / OPERATOR)
(702) 807-1718
Entity
Organization
Contact information
Practice address
3380 E RUSSELL RD, SUITE 104, LAS VEGAS, NV 89120-3402
(702) 476-0448
(702) 476-0449
Mailing address
3380 E RUSSELL RD, SUITE 104, LAS VEGAS, NV 89120-3402
(702) 476-0448
(702) 476-0449
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
04/28/2016
Last updated
04/29/2016
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