Provider Demographics
NPI:1093062200
Name:CITY, ANDRE
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:CITY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 EAST PATRIOT BLVD APT 251
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501
Mailing Address - Country:US
Mailing Address - Phone:775-336-3216
Mailing Address - Fax:775-359-9205
Practice Address - Street 1:690 EAST PATRIOT BLVD APT 251
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501
Practice Address - Country:US
Practice Address - Phone:775-336-3216
Practice Address - Fax:775-359-9205
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst