Provider Demographics
NPI:1366806556
Name:CARRILLO, CHRISTINE GARRISON
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:GARRISON
Last Name:CARRILLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 WINDSFORD CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7228
Mailing Address - Country:US
Mailing Address - Phone:760-550-9089
Mailing Address - Fax:
Practice Address - Street 1:5803 W CRAIG RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2536
Practice Address - Country:US
Practice Address - Phone:702-901-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician