Provider Demographics
NPI:1194221796
Name:EDMONDSON, RANESHA TIANA
Entity Type:Individual
Prefix:MS
First Name:RANESHA
Middle Name:TIANA
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 SHEEP RANCH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-5419
Mailing Address - Country:US
Mailing Address - Phone:502-229-1998
Mailing Address - Fax:
Practice Address - Street 1:7251 W LAKE MEAD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8380
Practice Address - Country:US
Practice Address - Phone:702-387-2300
Practice Address - Fax:702-387-2305
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NVLBA0718103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician