Provider Demographics
NPI:1245758598
Name:SINGLETON, COREY LEON
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:LEON
Last Name:SINGLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 CAMINO AL NORTE STE 284
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2420
Mailing Address - Country:US
Mailing Address - Phone:702-853-6719
Mailing Address - Fax:702-853-6722
Practice Address - Street 1:5135 CAMINO AL NORTE STE 284
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2420
Practice Address - Country:US
Practice Address - Phone:702-853-6719
Practice Address - Fax:702-853-6722
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1602498146Medicaid