Provider Demographics
NPI:1053624619
Name:PATRICIA ANN BRASSFIELD PHD LTD
Entity type:Organization
Organization Name:PATRICIA ANN BRASSFIELD PHD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRASSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:702-370-8484
Mailing Address - Street 1:PO BOX 35968
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5968
Mailing Address - Country:US
Mailing Address - Phone:702-370-8484
Mailing Address - Fax:775-537-2388
Practice Address - Street 1:7200 CATHEDRAL ROCK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0438
Practice Address - Country:US
Practice Address - Phone:702-370-8484
Practice Address - Fax:775-537-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPYO325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty