Organization
LIFE GATEWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA DENISE BOLDEN (PROVIDER)
(702) 812-2159
Entity
Organization
Contact information
Practice address
7548 W SAHARA AVE STE 101, LAS VEGAS, NV 89117-2779
(702) 823-2313
Mailing address
1957 SUSAN ST, LAS VEGAS, NV 89106-2654
(702) 812-2159
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710246921
—
NV
Enumeration date
08/27/2013
Last updated
08/27/2013
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