Provider Demographics
NPI:1093252165
Name:MATTOX, LOYD JR
Entity Type:Individual
Prefix:
First Name:LOYD
Middle Name:
Last Name:MATTOX
Suffix:JR
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 1:8022 S RAINBOW BLVD
Mailing Address - Street 2:122
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6477
Mailing Address - Country:US
Mailing Address - Phone:702-672-2678
Mailing Address - Fax:
Practice Address - Street 1:8022 S RAINBOW BLVD
Practice Address - Street 2:122
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6477
Practice Address - Country:US
Practice Address - Phone:702-672-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst