Provider Demographics
NPI:1528442282
Name:MARRIOTT, CHARLES EDWIN III (M ED, LBA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWIN
Last Name:MARRIOTT
Suffix:III
Gender:M
Credentials:M ED, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2500 CITRUS GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2387
Mailing Address - Country:US
Mailing Address - Phone:702-326-5996
Mailing Address - Fax:702-912-4662
Practice Address - Street 1:301 N PECOS RD
Practice Address - Street 2:STE E
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1349
Practice Address - Country:US
Practice Address - Phone:702-326-5996
Practice Address - Fax:702-912-4662
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBA0048103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst