Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1063848570 |
---|---|
Provider Name | Deshana Allen |
First Address | Las Vegas, NV 89109-8300 |
Second Address | Las Vegas, NV 89109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2013 |
Last Update Date | 03/08/2018 |