Provider Demographics
NPI:1053671404
Name:BOATWRIGHT, MARILYNN JOYCE
Entity Type:Individual
Prefix:MS
First Name:MARILYNN
Middle Name:JOYCE
Last Name:BOATWRIGHT
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 1:3674 N RANCHO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3110
Mailing Address - Country:US
Mailing Address - Phone:702-287-9922
Mailing Address - Fax:702-647-6233
Practice Address - Street 1:3674 N RANCHO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3110
Practice Address - Country:US
Practice Address - Phone:702-287-9922
Practice Address - Fax:702-647-6233
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health