Provider Demographics
NPI:1548554009
Name:SHAWNNYCE D DAWSON
Entity type:Organization
Organization Name:SHAWNNYCE D DAWSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWNNYCE
Authorized Official - Middle Name:DEONNE
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-812-3326
Mailing Address - Street 1:836 BUSSORA ROSE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-2425
Mailing Address - Country:US
Mailing Address - Phone:702-812-3326
Mailing Address - Fax:
Practice Address - Street 1:836 BUSSORA ROSE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-2425
Practice Address - Country:US
Practice Address - Phone:702-812-3326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101673467103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty