Provider Demographics
NPI:1841741972
Name:RUSSELL, CHEYENNE NICOLE (BA SOCIOLOGY)
Entity Type:Individual
Prefix:MS
First Name:CHEYENNE
Middle Name:NICOLE
Last Name:RUSSELL
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Gender:F
Credentials:BA SOCIOLOGY
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Mailing Address - Street 1:6765 TULIP FALLS DR
Mailing Address - Street 2:UNIT 2056
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-5016
Mailing Address - Country:US
Mailing Address - Phone:801-829-1092
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE
Practice Address - Street 2:STE D110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0842
Practice Address - Country:US
Practice Address - Phone:702-365-0600
Practice Address - Fax:702-365-0602
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst