Provider Demographics
NPI:1548058076
Name:WELKER, DEREK (RBT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:WELKER
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 CHANDLER AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4059
Mailing Address - Country:US
Mailing Address - Phone:172-571-0452
Mailing Address - Fax:702-441-9140
Practice Address - Street 1:2450 CHANDLER AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4059
Practice Address - Country:US
Practice Address - Phone:172-571-0452
Practice Address - Fax:702-441-9140
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty