Provider Demographics
NPI:1619374022
Name:YANCY, BRIAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:YANCY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6718 PANTHER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-9410
Mailing Address - Country:US
Mailing Address - Phone:775-412-2443
Mailing Address - Fax:
Practice Address - Street 1:2105 CAPURRO WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8518
Practice Address - Country:US
Practice Address - Phone:775-420-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist