Provider Demographics
NPI:1710452578
Name:MURPHY, JACKLYN DREW (BCBA,LBA)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:DREW
Last Name:MURPHY
Suffix:
Gender:F
Credentials:BCBA,LBA
Other - Prefix:
Other - First Name:JACKLYN
Other - Middle Name:DREW
Other - Last Name:CANADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6232 GUNDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3263
Mailing Address - Country:US
Mailing Address - Phone:702-901-3508
Mailing Address - Fax:
Practice Address - Street 1:9205 W RUSSELL RD STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1425
Practice Address - Country:US
Practice Address - Phone:671-487-5493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU1-20-40615103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherDO NOT HAVE ONE