Provider Demographics
NPI:1346582418
Name:MORAN, KEVIN A
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:MORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:A
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2740 SEARLES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-1515
Mailing Address - Country:US
Mailing Address - Phone:702-576-2750
Mailing Address - Fax:
Practice Address - Street 1:2740 SEARLES AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-1515
Practice Address - Country:US
Practice Address - Phone:702-576-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst