Provider Demographics
NPI:1629384722
Name:SAVATDY, SOMPONG
Entity Type:Individual
Prefix:
First Name:SOMPONG
Middle Name:
Last Name:SAVATDY
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 1:10012 BIDWELL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-3549
Mailing Address - Country:US
Mailing Address - Phone:702-626-4555
Mailing Address - Fax:
Practice Address - Street 1:10012 BIDWELL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-3549
Practice Address - Country:US
Practice Address - Phone:702-626-4555
Practice Address - Fax:702-216-2980
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional