Provider Demographics
NPI:1548784820
Name:HARVEY, TRAVONNE
Entity Type:Individual
Prefix:
First Name:TRAVONNE
Middle Name:
Last Name:HARVEY
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 1:3841 CANARY CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-9061
Mailing Address - Country:US
Mailing Address - Phone:702-918-4325
Mailing Address - Fax:
Practice Address - Street 1:3841 CANARY CEDAR ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-9061
Practice Address - Country:US
Practice Address - Phone:702-918-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health