| NPI | 1477908275 |
|---|---|
| Doing Business As | PHENOMENAL ANGELS |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY RASHONE BROUSSARD Owner / Operator 702-807-1718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2016-04-29 |