Provider Demographics
NPI:1134528201
Name:MARSHALL, TABREA RICHAYE
Entity type:Individual
Prefix:
First Name:TABREA
Middle Name:RICHAYE
Last Name:MARSHALL
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 1:2416 COCKATOO DR
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3137
Mailing Address - Country:US
Mailing Address - Phone:702-883-6612
Mailing Address - Fax:
Practice Address - Street 1:2416 COCKATOO DR
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3137
Practice Address - Country:US
Practice Address - Phone:702-883-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747A0650X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst