Healthcare Provider Details

I. General information

NPI: 1811336662
Provider Name (Legal Business Name): MR. STEFAN HARVILLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 SPANISH TOWN AVE
NORTH LAS VEGAS NV
89031-0903
US

IV. Provider business mailing address

2205 SPANISH TOWN AVE
NORTH LAS VEGAS NV
89031-0903
US

V. Phone/Fax

Practice location:
  • Phone: 702-658-9563
  • Fax: 702-636-9306
Mailing address:
  • Phone: 702-658-9563
  • Fax: 702-636-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: