Individual
SAMANTHA KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6600 W CHARLESTON BLVD, LAS VEGAS, NV 89146-9001
(702) 527-7510
Mailing address
771 AUTUMN MOON DR, LAS VEGAS, NV 89123-0713
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952782195
—
NV
Enumeration date
09/14/2017
Last updated
09/14/2017
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