Provider Demographics
NPI:1124364435
Name:MARR, VICTOR CHARLES
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:CHARLES
Last Name:MARR
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 1:5709 WIZARD WAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1347
Mailing Address - Country:US
Mailing Address - Phone:702-403-7140
Mailing Address - Fax:
Practice Address - Street 1:5709 WIZARD WAND ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1347
Practice Address - Country:US
Practice Address - Phone:702-403-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst