Provider Demographics
NPI:1649047853
Name:VIATOR, RYAN ROONEY (CADC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ROONEY
Last Name:VIATOR
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:ROONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC
Mailing Address - Street 1:10701 S EASTERN AVE APT 428
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2991
Mailing Address - Country:US
Mailing Address - Phone:702-466-0620
Mailing Address - Fax:
Practice Address - Street 1:3050 E DESERT INN RD STE 116
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3872
Practice Address - Country:US
Practice Address - Phone:702-796-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07524-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)