Provider Demographics
NPI:1558722199
Name:ROZZELL-ROBERTS, GLYNIS
Entity Type:Individual
Prefix:
First Name:GLYNIS
Middle Name:
Last Name:ROZZELL-ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 PIPELINE BEACH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-5618
Mailing Address - Country:US
Mailing Address - Phone:217-381-8219
Mailing Address - Fax:
Practice Address - Street 1:2104 PIPELINE BEACH CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-5618
Practice Address - Country:US
Practice Address - Phone:217-381-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst