Provider Demographics
NPI:1780321505
Name:REVELS, BIANCA LOUISE
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:LOUISE
Last Name:REVELS
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 1:1771 E FLAMINGO RD STE 215B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5154
Mailing Address - Country:US
Mailing Address - Phone:702-834-9260
Mailing Address - Fax:702-337-2027
Practice Address - Street 1:1771 E FLAMINGO RD STE 215B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5154
Practice Address - Country:US
Practice Address - Phone:702-834-9260
Practice Address - Fax:702-337-2027
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information