Provider Demographics
NPI:1639432693
Name:THEUS, KIMBERLY RANAE (BST)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RANAE
Last Name:THEUS
Suffix:
Gender:F
Credentials:BST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 TROUT LAKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115
Mailing Address - Country:US
Mailing Address - Phone:702-156-1171
Mailing Address - Fax:702-823-4781
Practice Address - Street 1:6759 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2002
Practice Address - Country:US
Practice Address - Phone:702-767-0579
Practice Address - Fax:702-823-4781
Is Sole Proprietor?:No
Enumeration Date:2012-06-24
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst