Provider Demographics
NPI:1518261726
Name:BOARDLEY, VERNON STEPHEN
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:STEPHEN
Last Name:BOARDLEY
Suffix:
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 1:3753 PREFONTAINE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-1572
Mailing Address - Country:US
Mailing Address - Phone:702-503-5070
Mailing Address - Fax:
Practice Address - Street 1:2026 SILVERTON DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1550
Practice Address - Country:US
Practice Address - Phone:702-617-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst