Provider Demographics
NPI:1952649113
Name:ELDER, FELECIA YVETTE
Entity Type:Individual
Prefix:
First Name:FELECIA
Middle Name:YVETTE
Last Name:ELDER
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 1:1845 YELLOW ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2041
Mailing Address - Country:US
Mailing Address - Phone:702-408-8730
Mailing Address - Fax:
Practice Address - Street 1:6365 SIMMONS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-7292
Practice Address - Country:US
Practice Address - Phone:702-278-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst