Provider Demographics
NPI:1134542152
Name:DUE SEASON INC
Entity type:Organization
Organization Name:DUE SEASON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WAIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK-STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-708-1275
Mailing Address - Street 1:3726 NEWTON FALLS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-1407
Mailing Address - Country:US
Mailing Address - Phone:702-708-1275
Mailing Address - Fax:
Practice Address - Street 1:6533 BAILEY TESS CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-1305
Practice Address - Country:US
Practice Address - Phone:702-708-1275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty