Provider Demographics
NPI:1366178675
Name:THERAPY BEHAVIOR SERVICE LLC
Entity type:Organization
Organization Name:THERAPY BEHAVIOR SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER, SLP
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANVELL
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER, SLP
Authorized Official - Phone:714-943-7146
Mailing Address - Street 1:8670 W CHEYENNE AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7457
Mailing Address - Country:US
Mailing Address - Phone:725-202-1497
Mailing Address - Fax:725-202-1500
Practice Address - Street 1:8670 W CHEYENNE AVE STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7457
Practice Address - Country:US
Practice Address - Phone:725-202-1497
Practice Address - Fax:725-202-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty