Provider Demographics
NPI:1053204768
Name:SUST DUENAS, ALICIA MAYLEN
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MAYLEN
Last Name:SUST DUENAS
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 1:8805 JEFFREYS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4877
Mailing Address - Country:US
Mailing Address - Phone:702-574-9990
Mailing Address - Fax:
Practice Address - Street 1:8805 JEFFREYS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4877
Practice Address - Country:US
Practice Address - Phone:702-574-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-25-440974106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician