Provider Demographics
NPI:1891164877
Name:SMITH, VERETTA AZLIE
Entity Type:Individual
Prefix:
First Name:VERETTA
Middle Name:AZLIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERETTA
Other - Middle Name:AZLIE
Other - Last Name:CAREY-LOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6435 GRASS MEADOWS DR
Mailing Address - Street 2:146
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-2874
Mailing Address - Country:US
Mailing Address - Phone:702-469-4810
Mailing Address - Fax:
Practice Address - Street 1:1 W OWENS AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6865
Practice Address - Country:US
Practice Address - Phone:702-385-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst