Provider Demographics
NPI:1346641776
Name:SARGENT, EVAN KENNEDY (CPC)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:KENNEDY
Last Name:SARGENT
Suffix:
Gender:M
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 N BUFFALO DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129
Mailing Address - Country:US
Mailing Address - Phone:702-515-1374
Mailing Address - Fax:702-331-3098
Practice Address - Street 1:3321 N BUFFALO DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129
Practice Address - Country:US
Practice Address - Phone:702-515-1374
Practice Address - Fax:702-331-3098
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NVCP0218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)