Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1154695179 |
---|---|
Provider Name | Deshawn Richard |
First Address | North Las Vegas, NV 89031-7917 |
Second Address | North Las Vegas, NV 89031-7917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2012 |
Last Update Date | 08/03/2012 |