Provider Demographics
NPI:1699203810
Name:SAETEURN, ANDY
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:SAETEURN
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 1:3900 W CHARLESTON BLVD # Y
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1628
Mailing Address - Country:US
Mailing Address - Phone:702-992-3577
Mailing Address - Fax:877-214-5160
Practice Address - Street 1:3900 W CHARLESTON BLVD # Y
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1628
Practice Address - Country:US
Practice Address - Phone:702-992-3577
Practice Address - Fax:877-214-5160
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-17-35988106S00000X
NVLBA0342103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician