Provider Demographics
NPI:1205364627
Name:ALBRITTON, SHIRLEY ANN
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:ALBRITTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHIRLEY
Other - Middle Name:ANN
Other - Last Name:ALBRITTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2400 GOLDENMOON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4477
Mailing Address - Country:US
Mailing Address - Phone:702-416-0553
Mailing Address - Fax:
Practice Address - Street 1:2301 NORTH DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-8910
Practice Address - Country:US
Practice Address - Phone:702-790-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV83537101YP1600X
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1402652846OtherLICENSE