Provider Demographics
NPI:1871815472
Name:BADGER, MARANDIA
Entity Type:Individual
Prefix:
First Name:MARANDIA
Middle Name:
Last Name:BADGER
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 1:4180 S PECOS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5074
Mailing Address - Country:US
Mailing Address - Phone:702-685-1899
Mailing Address - Fax:702-685-1799
Practice Address - Street 1:3304 CONTERRA PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6537
Practice Address - Country:US
Practice Address - Phone:702-685-1899
Practice Address - Fax:702-685-1799
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGF-125401000-0015OtherFACILITY NUMBER