Provider Demographics
NPI:1396218699
Name:PONDER, BEVERLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:PONDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 N BOULDER HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4120
Mailing Address - Country:US
Mailing Address - Phone:702-558-8600
Mailing Address - Fax:702-558-8700
Practice Address - Street 1:1536 N BOULDER HWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4120
Practice Address - Country:US
Practice Address - Phone:702-558-8600
Practice Address - Fax:702-558-8700
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA057830456OtherDRIVERS LICENSE