Provider Demographics
NPI:1215056478
Name:TANDEM THERAPY SERVICES
Entity type:Organization
Organization Name:TANDEM THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST/BEHAVIOR ANALYST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP, BCBA
Authorized Official - Phone:702-292-2012
Mailing Address - Street 1:7261 W CHARLESTON BLVD
Mailing Address - Street 2:#101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1636
Mailing Address - Country:US
Mailing Address - Phone:702-396-0101
Mailing Address - Fax:702-222-0212
Practice Address - Street 1:7261 W CHARLESTON BLVD
Practice Address - Street 2:#101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1636
Practice Address - Country:US
Practice Address - Phone:702-396-0101
Practice Address - Fax:702-222-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP620235Z00000X
NVLBA0027251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508345Medicaid