Provider Demographics
NPI:1073388328
Name:PRINCER, MARIEEV KRISTA BEDUYA (MFT-INTERN, ATR-P)
Entity Type:Individual
Prefix:
First Name:MARIEEV KRISTA
Middle Name:BEDUYA
Last Name:PRINCER
Suffix:
Gender:F
Credentials:MFT-INTERN, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5853 MARIA DEL MAR ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-7299
Mailing Address - Country:US
Mailing Address - Phone:725-225-5315
Mailing Address - Fax:
Practice Address - Street 1:2723 E RUSSELL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2426
Practice Address - Country:US
Practice Address - Phone:702-659-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4300106H00000X
NV23-449221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist