Provider Demographics
NPI:1376183913
Name:PEASE, TAYLOR NICOLE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICOLE
Last Name:PEASE
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 1:3037 E WARM SPRINGS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3759
Mailing Address - Country:US
Mailing Address - Phone:702-780-8447
Mailing Address - Fax:702-780-8491
Practice Address - Street 1:3037 E WARM SPRINGS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3759
Practice Address - Country:US
Practice Address - Phone:702-780-8447
Practice Address - Fax:702-780-8491
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician