Provider Demographics
NPI:1457733388
Name:EWELL, DARRELL
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:EWELL
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 1:2330 PASEO DEL PRADO
Mailing Address - Street 2:SUITE C105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4359
Mailing Address - Country:US
Mailing Address - Phone:702-823-2313
Mailing Address - Fax:
Practice Address - Street 1:2330 PASEO DEL PRADO
Practice Address - Street 2:SUITE C105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4359
Practice Address - Country:US
Practice Address - Phone:702-823-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-27
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst