Provider Demographics
NPI:1295974632
Name:WYKOFF, BEVERLY YOUNG (MSW,MS,MA)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:YOUNG
Last Name:WYKOFF
Suffix:
Gender:F
Credentials:MSW,MS,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 PLAZA DEL PADRE
Mailing Address - Street 2:SPANISH OAKS
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3917
Mailing Address - Country:US
Mailing Address - Phone:702-486-4400
Mailing Address - Fax:702-486-8367
Practice Address - Street 1:2113 PLAZA DEL PADRE
Practice Address - Street 2:SPANISH OAKS
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-3917
Practice Address - Country:US
Practice Address - Phone:702-743-7035
Practice Address - Fax:702-486-8367
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC2994103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst