Provider Demographics
NPI:1558695270
Name:BHATTACHARYYA, DEBADATTA (PHD, LMFT, LADC)
Entity Type:Individual
Prefix:MRS
First Name:DEBADATTA
Middle Name:
Last Name:BHATTACHARYYA
Suffix:
Gender:F
Credentials:PHD, LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 DRY CLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7129
Mailing Address - Country:US
Mailing Address - Phone:702-612-4412
Mailing Address - Fax:
Practice Address - Street 1:8416 DRY CLIFF CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7129
Practice Address - Country:US
Practice Address - Phone:702-612-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV877101YA0400X
NV654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)