Provider Demographics
NPI:1871695775
Name:LAVARIAS, LEI LOPEZ (PSYD)
Entity type:Individual
Prefix:
First Name:LEI
Middle Name:LOPEZ
Last Name:LAVARIAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 W LAKE MEAD BLVD
Mailing Address - Street 2:#294
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108
Mailing Address - Country:US
Mailing Address - Phone:702-303-2503
Mailing Address - Fax:
Practice Address - Street 1:6170 W LAKE MEAD BLVD
Practice Address - Street 2:#294
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108
Practice Address - Country:US
Practice Address - Phone:702-303-2503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0458103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2602228Medicaid
P36919Medicare UPIN
NV37429Medicare ID - Type UnspecifiedNORIDIAN