Provider Demographics
NPI:1356813836
Name:ANASTASIA, PHILIP WILLIAM JR
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:WILLIAM
Last Name:ANASTASIA
Suffix:JR
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 1:9286 MARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5049
Mailing Address - Country:US
Mailing Address - Phone:805-616-7676
Mailing Address - Fax:
Practice Address - Street 1:5510 S FORT APACHE RD STE 12
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7700
Practice Address - Country:US
Practice Address - Phone:805-616-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0934106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist