Provider Demographics
NPI:1699384230
Name:BRABSON, NATASHA MAYA
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MAYA
Last Name:BRABSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 ASCONA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6190
Mailing Address - Country:US
Mailing Address - Phone:805-245-1023
Mailing Address - Fax:
Practice Address - Street 1:3341 ASCONA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6190
Practice Address - Country:US
Practice Address - Phone:805-245-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1404586160Medicaid