Provider Demographics
NPI:1326811662
Name:AJIMATI, TYNISIA K (RBT)
Entity type:Individual
Prefix:MRS
First Name:TYNISIA
Middle Name:K
Last Name:AJIMATI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:TYNISIA
Other - Middle Name:K
Other - Last Name:EDWARDS-BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:4220 LAS VEGAS BLVD N APT 207
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-1508
Mailing Address - Country:US
Mailing Address - Phone:786-854-9950
Mailing Address - Fax:
Practice Address - Street 1:7251 W LAKE MEAD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8380
Practice Address - Country:US
Practice Address - Phone:702-387-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty