Provider Demographics
NPI:1063848570
Name:ALLEN, DESHANA
Entity Type:Individual
Prefix:
First Name:DESHANA
Middle Name:
Last Name:ALLEN
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 1:2620 S MARYLAND PKWY # 14-429
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-8300
Mailing Address - Country:US
Mailing Address - Phone:702-591-9336
Mailing Address - Fax:702-946-9472
Practice Address - Street 1:2620 S MARYLAND PKWY # 14-429
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:702-591-9336
Practice Address - Fax:702-946-9472
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner