Provider Demographics
NPI:1619417318
Name:VILLAR, GINA (RBT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:VILLAR
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6027
Mailing Address - Country:US
Mailing Address - Phone:702-538-1530
Mailing Address - Fax:
Practice Address - Street 1:220 PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6027
Practice Address - Country:US
Practice Address - Phone:702-538-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-16-23043106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician