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General NPI Number Information
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NPI Number | 1659642965
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Entity Type | Organization
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Legal Business Name | DEVERA PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 555 CALIFORNIA AVE
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City | BOULDER CITY
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State | NV
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Zip | 89005-2757
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Country | US
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Telephone | 702-293-5945
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Fax | 702-293-5168
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Provider Business Mailing Address
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Address Line | 555 CALIFORNIA AVE
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City | BOULDER CITY
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State | NV
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Zip | 89005-2757
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Country | US
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Telephone | 702-293-5945
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Fax | 702-293-5168
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUE BERG
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Credential |
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Telephone | 702-296-5945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY0619
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License Number State | NV
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