Provider Demographics
NPI:1144688649
Name:SIEGRIST, WILLIAM CYRIL (QMHA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CYRIL
Last Name:SIEGRIST
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 TECH CENTER CT STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0804
Mailing Address - Country:US
Mailing Address - Phone:702-588-4991
Mailing Address - Fax:
Practice Address - Street 1:2441 TECH CENTER CT STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0804
Practice Address - Country:US
Practice Address - Phone:702-588-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner