Provider Demographics
NPI:1689190563
Name:RENTIE, BRIAN D JR
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:RENTIE
Suffix:JR
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 1:4730 E CRAIG RD UNIT 2160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-1864
Mailing Address - Country:US
Mailing Address - Phone:702-413-8668
Mailing Address - Fax:
Practice Address - Street 1:4730 E. CRAIG RD #2160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115
Practice Address - Country:US
Practice Address - Phone:702-413-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician