Provider Demographics
NPI:1053954172
Name:HEATH, SHAWNA LYNN
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LYNN
Last Name:HEATH
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 1:2860 PRECISO LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2418
Mailing Address - Country:US
Mailing Address - Phone:702-883-4026
Mailing Address - Fax:
Practice Address - Street 1:7125 GRAND MONTECITO PKWY STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0261
Practice Address - Country:US
Practice Address - Phone:702-883-4026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician