Provider Demographics
NPI:1518211531
Name:BENNETT, DRINA JAYREAL
Entity Type:Individual
Prefix:MISS
First Name:DRINA
Middle Name:JAYREAL
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 BRAMBLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4725
Mailing Address - Country:US
Mailing Address - Phone:775-343-9693
Mailing Address - Fax:
Practice Address - Street 1:5715 W ALEXANDER RD
Practice Address - Street 2:SUITE 155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2800
Practice Address - Country:US
Practice Address - Phone:702-586-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst