Provider Demographics
NPI:1144417734
Name:REDD, SHEA S (BCBA)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:S
Last Name:REDD
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 CRESCENT RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0302
Mailing Address - Country:US
Mailing Address - Phone:702-600-9082
Mailing Address - Fax:
Practice Address - Street 1:8720 CRESCENT RIDGE LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0302
Practice Address - Country:US
Practice Address - Phone:702-600-9082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1-13-12937103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTREDDSOtherSWBHC STAFF CODE