Provider Demographics
NPI:1184277501
Name:MAPA, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MAPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S EASTERN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0840
Mailing Address - Country:US
Mailing Address - Phone:702-476-0262
Mailing Address - Fax:
Practice Address - Street 1:4000 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0840
Practice Address - Country:US
Practice Address - Phone:702-476-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty