Provider Demographics
NPI:1861181638
Name:TRIFECTA TEAM JASA PLLC
Entity type:Organization
Organization Name:TRIFECTA TEAM JASA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNOHA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:702-329-0125
Mailing Address - Street 1:PO BOX 370846
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0846
Mailing Address - Country:US
Mailing Address - Phone:702-688-3230
Mailing Address - Fax:
Practice Address - Street 1:7375 PRAIRIE FALCON RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0810
Practice Address - Country:US
Practice Address - Phone:702-329-0125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty