Provider Demographics
NPI:1386019958
Name:BELL, ANTANIC VICTORIA
Entity Type:Individual
Prefix:MISS
First Name:ANTANIC
Middle Name:VICTORIA
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANTANIC
Other - Middle Name:VICTORIA
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4854 NARA VISTA WAY
Mailing Address - Street 2:APT 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-7097
Mailing Address - Country:US
Mailing Address - Phone:702-609-1320
Mailing Address - Fax:
Practice Address - Street 1:4854 NARA VISTA WAY
Practice Address - Street 2:APT 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-7097
Practice Address - Country:US
Practice Address - Phone:702-609-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2104092388103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst