Provider Demographics
NPI:1821699000
Name:SURYA, BETHSABE (CPC INTERN)
Entity Type:Individual
Prefix:
First Name:BETHSABE
Middle Name:
Last Name:SURYA
Suffix:
Gender:F
Credentials:CPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 VINCELLI AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-4811
Mailing Address - Country:US
Mailing Address - Phone:702-581-7130
Mailing Address - Fax:
Practice Address - Street 1:3808 VINCELLI AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-4811
Practice Address - Country:US
Practice Address - Phone:702-581-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health