Provider Demographics
NPI:1043780695
Name:PROUD MOMENTS ABA OF NEVADA LLC
Entity type:Organization
Organization Name:PROUD MOMENTS ABA OF NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-215-5311
Mailing Address - Street 1:350 5TH AVE STE 6115
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10118-6002
Mailing Address - Country:US
Mailing Address - Phone:718-215-5311
Mailing Address - Fax:
Practice Address - Street 1:9089 S PECOS RD STE 3600
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7186
Practice Address - Country:US
Practice Address - Phone:702-680-1523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-13-13480OtherBACB