Provider Demographics
NPI:1538513569
Name:JOSH D DWIRE PSYD PLLC
Entity Type:Organization
Organization Name:JOSH D DWIRE PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DWIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:702-831-0788
Mailing Address - Street 1:5546 CAMINO AL NORTE STE 2-298
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0805
Mailing Address - Country:US
Mailing Address - Phone:702-831-0788
Mailing Address - Fax:702-463-9087
Practice Address - Street 1:720 W CHEYENNE AVE
Practice Address - Street 2:STE 50
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7807
Practice Address - Country:US
Practice Address - Phone:702-831-0788
Practice Address - Fax:702-463-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0737103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV13066015100726Medicare PIN