Provider Demographics
NPI:1669710646
Name:CHURCH, JAMES TIMOTHY (BCBA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:TIMOTHY
Last Name:CHURCH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 PALM PINNACLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5682
Mailing Address - Country:US
Mailing Address - Phone:307-575-2044
Mailing Address - Fax:
Practice Address - Street 1:7391 W CHARLESTON BLVD # 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1577
Practice Address - Country:US
Practice Address - Phone:702-396-0101
Practice Address - Fax:702-222-0212
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NVLBA0080103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst