Healthcare Provider Details

I. General information

NPI: 1568883916
Provider Name (Legal Business Name): ATLAS STEVE BAUTISTA B.A. PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2014
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3671 VIA ALLEGRO
HENDERSON NV
89044-1864
US

IV. Provider business mailing address

1101 RED VENTURES DR
FORT MILL SC
29707-5005
US

V. Phone/Fax

Practice location:
  • Phone: 386-405-2907
  • Fax: 386-405-2907
Mailing address:
  • Phone: 980-785-0567
  • Fax: 980-785-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number358484125
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: