Provider Demographics
NPI:1265014955
Name:CANALES MACEO, KATHERYN
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:CANALES MACEO
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 1:8378 HIDDEN CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-4892
Mailing Address - Country:US
Mailing Address - Phone:702-857-0784
Mailing Address - Fax:
Practice Address - Street 1:2785 E DESERT INN RD STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3624
Practice Address - Country:US
Practice Address - Phone:702-665-9793
Practice Address - Fax:702-685-7770
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician