Healthcare Provider Details

I. General information

NPI: 1417395211
Provider Name (Legal Business Name): BECKY ELLEN CREE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PASEO VERDE PKWY STE 190
HENDERSON NV
89052-2703
US

IV. Provider business mailing address

2200 PASEO VERDE PKWY STE 190
HENDERSON NV
89052-2703
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-4871
  • Fax: 702-589-4872
Mailing address:
  • Phone: 702-589-4871
  • Fax: 702-589-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP5215
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: