Provider Demographics
NPI:1770098741
Name:ATKINSON, ANDREE J
Entity type:Individual
Prefix:
First Name:ANDREE
Middle Name:J
Last Name:ATKINSON
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 1:3560 W CHEYENNE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8261
Mailing Address - Country:US
Mailing Address - Phone:702-331-1917
Mailing Address - Fax:
Practice Address - Street 1:3560 W CHEYENNE AVE STE 120
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8261
Practice Address - Country:US
Practice Address - Phone:702-331-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1401685008Medicaid