Healthcare Provider Details

I. General information

NPI: 1902881709
Provider Name (Legal Business Name): JUDY SEYMORE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 W CHARLESTON BLVD #4
LAS VEGAS NV
89117-9088
US

IV. Provider business mailing address

PO BOX 34330
LAS VEGAS NV
89133-4330
US

V. Phone/Fax

Practice location:
  • Phone: 702-220-7633
  • Fax: 702-240-8052
Mailing address:
  • Phone: 702-220-7633
  • Fax: 702-240-8052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberV36057
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: