Provider Demographics
NPI:1922618826
Name:REID, NATALIE LYNETTE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LYNETTE
Last Name:REID
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 1:4325 N RANCHO DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3439
Mailing Address - Country:US
Mailing Address - Phone:702-820-8891
Mailing Address - Fax:719-213-2920
Practice Address - Street 1:4325 N RANCHO DR STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3439
Practice Address - Country:US
Practice Address - Phone:702-820-8891
Practice Address - Fax:719-213-2920
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-20-130800106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician