Provider Demographics
NPI:1417582354
Name:MAYERS, KATHLEEN S (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:MAYERS
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 1:305 PRINCE CHARMING CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8001
Mailing Address - Country:US
Mailing Address - Phone:702-809-3885
Mailing Address - Fax:
Practice Address - Street 1:7854 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1944
Practice Address - Country:US
Practice Address - Phone:702-809-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0369103T00000X
WA400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty