Provider Demographics
NPI:1376952879
Name:GARNESS, NICK EDWARD I
Entity Type:Individual
Prefix:MR
First Name:NICK
Middle Name:EDWARD
Last Name:GARNESS
Suffix:I
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 1:4212 LOWER SAXON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89085-4468
Mailing Address - Country:US
Mailing Address - Phone:702-728-6378
Mailing Address - Fax:
Practice Address - Street 1:4212 LOWER SAXON AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89085-4468
Practice Address - Country:US
Practice Address - Phone:702-728-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst