MEDICARE: DR. DEVA MICHELE DORRIS PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	30396627	PA
2	103TC0700X	Clinical Psychologist	PY1053	NV

General Provider Information

NPI Number	:	1225582265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVA MICHELE DORRIS PSY.D.

Provider Business Mailing Address
First Line	:	3211 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3157
Country	:	US
Telephone Number	:	702-912-5848
Fax Number	:

Provider Business Practice Location Address
First Line	:	3211 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3157
Country	:	US
Telephone Number	:	702-912-5848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	03/01/2022

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