Provider Demographics
NPI:1043602071
Name:PEDDIESON, ABBIGAIL (MFT-LICENSED INTERN)
Entity Type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:
Last Name:PEDDIESON
Suffix:
Gender:F
Credentials:MFT-LICENSED INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 VALLEY LIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-2651
Mailing Address - Country:US
Mailing Address - Phone:702-758-4006
Mailing Address - Fax:
Practice Address - Street 1:3425 CLIFF SHADOWS PKWY
Practice Address - Street 2:150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-5111
Practice Address - Country:US
Practice Address - Phone:702-758-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0465106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist