Provider Demographics
NPI:1073397675
Name:DECLOUETTE-SANDERS, MARI'YELL
Entity Type:Individual
Prefix:
First Name:MARI'YELL
Middle Name:
Last Name:DECLOUETTE-SANDERS
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 1:5685 ADAVAN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3966
Mailing Address - Country:US
Mailing Address - Phone:725-267-9233
Mailing Address - Fax:
Practice Address - Street 1:4717 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4544
Practice Address - Country:US
Practice Address - Phone:602-472-3085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician