Provider Demographics
NPI:1538572300
Name:SOUTHWEST AUTISM & BEHAVIORAL SOLUTIONS
Entity type:Organization
Organization Name:SOUTHWEST AUTISM & BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FESSEWNDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:702-499-7502
Mailing Address - Street 1:2700 E SUNSET RD STE 24
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3519
Mailing Address - Country:US
Mailing Address - Phone:702-270-3219
Mailing Address - Fax:
Practice Address - Street 1:2700 E SUNSET RD STE 24
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3519
Practice Address - Country:US
Practice Address - Phone:702-270-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty