Provider Demographics
NPI:1164104741
Name:KEPHART, CALEY (CPC-I)
Entity Type:Individual
Prefix:
First Name:CALEY
Middle Name:
Last Name:KEPHART
Suffix:
Gender:F
Credentials:CPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10658 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-4600
Mailing Address - Country:US
Mailing Address - Phone:702-467-7078
Mailing Address - Fax:
Practice Address - Street 1:2445 FIRE MESA ST STE 190
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9015
Practice Address - Country:US
Practice Address - Phone:702-456-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health