Provider Demographics
NPI:1033848148
Name:TAYLOR, DEJANAE MONIQUE
Entity Type:Individual
Prefix:
First Name:DEJANAE
Middle Name:MONIQUE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 W CHEYENNE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2254
Mailing Address - Country:US
Mailing Address - Phone:702-636-8729
Mailing Address - Fax:702-441-1808
Practice Address - Street 1:3110 W CHEYENNE AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2254
Practice Address - Country:US
Practice Address - Phone:702-636-8729
Practice Address - Fax:702-441-1808
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst