Provider Demographics
NPI:1548975311
Name:MARTIN, EBONY P (RBT)
Entity type:Individual
Prefix:MISS
First Name:EBONY
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MISS
Other - First Name:EBONY
Other - Middle Name:P
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:4801 E SAHARA AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6318
Mailing Address - Country:US
Mailing Address - Phone:907-723-2749
Mailing Address - Fax:
Practice Address - Street 1:7390 W SAHARA AVE UNIT 250-280
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2763
Practice Address - Country:US
Practice Address - Phone:702-900-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-22-249281106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician