Provider Demographics
NPI:1114333515
Name:BAGGETT, BILLY
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:BAGGETT
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 1:5313 VARIETY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0424
Mailing Address - Country:US
Mailing Address - Phone:702-235-2219
Mailing Address - Fax:
Practice Address - Street 1:5313 VARIETY AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0424
Practice Address - Country:US
Practice Address - Phone:702-235-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor