Provider Demographics
NPI:1275836389
Name:DYBEVIK, DONALD
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:DYBEVIK
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 1:6759 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2002
Mailing Address - Country:US
Mailing Address - Phone:702-467-1377
Mailing Address - Fax:702-586-0665
Practice Address - Street 1:6759 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2002
Practice Address - Country:US
Practice Address - Phone:702-467-1377
Practice Address - Fax:702-586-0665
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst