Provider Demographics
NPI:1598212086
Name:LINDSEY, DESIRAE NICOLE
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:NICOLE
Last Name:LINDSEY
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 1:205 V AND T WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-9709
Mailing Address - Country:US
Mailing Address - Phone:702-340-3160
Mailing Address - Fax:
Practice Address - Street 1:205 V AND T WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-9709
Practice Address - Country:US
Practice Address - Phone:702-340-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst