Healthcare Provider Details

I. General information

NPI: 1437423712
Provider Name (Legal Business Name): MISS BRITTANY ARIANA WILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2012
Last Update Date: 03/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 PLAYA DE CARMEN WAY
NORTH LAS VEGAS NV
89086-1418
US

IV. Provider business mailing address

6424 PLAYA DE CARMEN WAY
NORTH LAS VEGAS NV
89086-1418
US

V. Phone/Fax

Practice location:
  • Phone: 702-985-9795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: