Provider Demographics
NPI:1558439935
Name:GENNIS, DAVID PATRICK (PSYD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PATRICK
Last Name:GENNIS
Suffix:
Gender:M
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 PERCHING BIRD LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2358
Mailing Address - Country:US
Mailing Address - Phone:480-268-5723
Mailing Address - Fax:
Practice Address - Street 1:5915 S RAINBOW BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2558
Practice Address - Country:US
Practice Address - Phone:702-209-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46820106H00000X
NV#01166106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist