Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1295132439 |
---|---|
Provider Name | Marvin Berry |
First Address | Henderson, NV 89014-7632 |
Second Address | Henderson, NV 89014-7632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2014 |
Last Update Date | 03/12/2014 |