Provider Demographics
NPI:1184482549
Name:KETCHUM, NATALIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:KETCHUM
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 1:9089 S PECOS RD STE 3400
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7184
Mailing Address - Country:US
Mailing Address - Phone:702-867-5810
Mailing Address - Fax:
Practice Address - Street 1:9089 S PECOS RD STE 3400
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7184
Practice Address - Country:US
Practice Address - Phone:702-867-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician