Provider Demographics
NPI:1134481856
Name:BURSEY, STEPHENIA
Entity type:Individual
Prefix:
First Name:STEPHENIA
Middle Name:
Last Name:BURSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHENIA
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3560 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8260
Mailing Address - Country:US
Mailing Address - Phone:702-258-8023
Mailing Address - Fax:
Practice Address - Street 1:3560 W CHEYENNE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8260
Practice Address - Country:US
Practice Address - Phone:702-258-8023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner