Provider Demographics
NPI:1215440474
Name:GREEN, CAMERON CODY (BCBA)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:CODY
Last Name:GREEN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50843
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435-0843
Mailing Address - Country:US
Mailing Address - Phone:775-354-1380
Mailing Address - Fax:775-354-1474
Practice Address - Street 1:4840 VISTA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-2850
Practice Address - Country:US
Practice Address - Phone:775-354-1380
Practice Address - Fax:775-354-1474
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBA0125103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst