Provider Demographics
NPI:1700205119
Name:STANSBERRY, DEANDREA
Entity Type:Individual
Prefix:
First Name:DEANDREA
Middle Name:
Last Name:STANSBERRY
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 1:8892 OCEANSIDE SLOPES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-7524
Mailing Address - Country:US
Mailing Address - Phone:702-204-8332
Mailing Address - Fax:
Practice Address - Street 1:8892 OCEANSIDE SLOPES AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-7524
Practice Address - Country:US
Practice Address - Phone:702-204-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131681054103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst