Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1245522374 |
---|---|
Provider Name | Beverly Mathis |
First Address | North Las Vegas, NV 89032-4329 |
Second Address | North Las Vegas, NV 89032-4329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2011 |
Last Update Date | 08/05/2011 |