Provider Demographics
NPI:1194223958
Name:TERRY, NATASHA DENEE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:DENEE
Last Name:TERRY
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 1:2521 CHARLEVILLE AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-1582
Mailing Address - Country:US
Mailing Address - Phone:702-980-3244
Mailing Address - Fax:702-486-1404
Practice Address - Street 1:2350 S JONES BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3124
Practice Address - Country:US
Practice Address - Phone:702-980-3244
Practice Address - Fax:702-486-1404
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst