Provider Demographics
NPI:1568055374
Name:MOLITOR, LYNNETTE Y
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:Y
Last Name:MOLITOR
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 1:6065 POOH CORNER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3940
Mailing Address - Country:US
Mailing Address - Phone:702-577-8703
Mailing Address - Fax:702-922-6600
Practice Address - Street 1:2881 S VALLEY VIEW BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0145
Practice Address - Country:US
Practice Address - Phone:702-922-7015
Practice Address - Fax:702-922-6600
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCERTIFICATE106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician