Provider Demographics
NPI:1689174732
Name:MAZARIEGOS, GLADYS MICHELLE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:MICHELLE
Last Name:MAZARIEGOS
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9089 S PECOS RD STE 3400
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7184
Mailing Address - Country:US
Mailing Address - Phone:702-867-5810
Mailing Address - Fax:702-867-5811
Practice Address - Street 1:9089 S PECOS RD STE 3400
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7184
Practice Address - Country:US
Practice Address - Phone:702-867-5810
Practice Address - Fax:702-867-5811
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1-21-46871103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1-21-46871OtherBOARD CERTIFIED BEHAVIOR ANALYST