Provider Demographics
NPI:1790024792
Name:STUBBLEFIELD, REUBEN
Entity Type:Individual
Prefix:MR
First Name:REUBEN
Middle Name:
Last Name:STUBBLEFIELD
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 1:3651 N RANCHO DR
Mailing Address - Street 2:UNIT 231
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3129
Mailing Address - Country:US
Mailing Address - Phone:702-981-0930
Mailing Address - Fax:
Practice Address - Street 1:5715 W ALEXANDER RD
Practice Address - Street 2:SUITE 155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2800
Practice Address - Country:US
Practice Address - Phone:702-586-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst