Provider Demographics
NPI:1669026712
Name:GLOVER, DE'ONTEZ ZAMAR
Entity Type:Individual
Prefix:
First Name:DE'ONTEZ
Middle Name:ZAMAR
Last Name:GLOVER
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 1:2245 MARLBORO DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3771
Mailing Address - Country:US
Mailing Address - Phone:702-712-0002
Mailing Address - Fax:702-877-5697
Practice Address - Street 1:212 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2657
Practice Address - Country:US
Practice Address - Phone:702-712-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst