Provider Demographics
NPI:1346802501
Name:PECKHAM SMITH, VICTORIA KYLEE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KYLEE
Last Name:PECKHAM SMITH
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 1:3050 S NELLIS BLVD APT 2032
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7775
Mailing Address - Country:US
Mailing Address - Phone:916-993-0037
Mailing Address - Fax:
Practice Address - Street 1:6363 S PECOS RD STE 206
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-6293
Practice Address - Country:US
Practice Address - Phone:702-850-2691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician