Provider Demographics
NPI:1649696345
Name:BRACEY, RICCO
Entity type:Individual
Prefix:
First Name:RICCO
Middle Name:
Last Name:BRACEY
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 1:4342 CAPPAS ST
Mailing Address - Street 2:APT.102 BLDG 15
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-1633
Mailing Address - Country:US
Mailing Address - Phone:702-401-3131
Mailing Address - Fax:
Practice Address - Street 1:231 S 3RD ST
Practice Address - Street 2:SUITE# 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-5914
Practice Address - Country:US
Practice Address - Phone:702-485-4937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst