Provider Demographics
NPI:1023524063
Name:WIER, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 SKY POINTE DR # 144
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4070
Mailing Address - Country:US
Mailing Address - Phone:027-704-5112
Mailing Address - Fax:866-633-9254
Practice Address - Street 1:6628 SKY POINTE DR # 144
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4070
Practice Address - Country:US
Practice Address - Phone:702-704-5112
Practice Address - Fax:866-633-9254
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NVRBT-18-50488106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT-18-50488OtherBACB
NV1023524063Medicaid