Provider Demographics
NPI:1578812152
Name:DOW, SUSAN YALE (LADC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:YALE
Last Name:DOW
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2684
Mailing Address - Country:US
Mailing Address - Phone:702-474-4104
Mailing Address - Fax:702-474-4108
Practice Address - Street 1:1800 INDUSTRIAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2684
Practice Address - Country:US
Practice Address - Phone:702-474-4104
Practice Address - Fax:702-474-4108
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01518-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)