Provider Demographics
NPI:1235753096
Name:ARCHULETA, DEANNA DELLA
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:DELLA
Last Name:ARCHULETA
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 1:3455 W CRAIG RD STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5119
Mailing Address - Country:US
Mailing Address - Phone:702-640-0949
Mailing Address - Fax:702-921-0757
Practice Address - Street 1:3455 W CRAIG RD STE C
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5119
Practice Address - Country:US
Practice Address - Phone:702-640-0949
Practice Address - Fax:702-921-0757
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health