Provider Demographics
NPI:1710437827
Name:HARPER, IVAN WAYNE PATRICK
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:WAYNE PATRICK
Last Name:HARPER
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 1:5302 SPRING CANYON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2915
Mailing Address - Country:US
Mailing Address - Phone:702-758-2413
Mailing Address - Fax:
Practice Address - Street 1:5302 SPRING CANYON ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2915
Practice Address - Country:US
Practice Address - Phone:702-758-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician