Provider Demographics
NPI:1215458039
Name:PAGELA, GREG JORGE
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:JORGE
Last Name:PAGELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 E LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6514
Mailing Address - Country:US
Mailing Address - Phone:702-749-8500
Mailing Address - Fax:702-749-8509
Practice Address - Street 1:2820 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6514
Practice Address - Country:US
Practice Address - Phone:702-749-8500
Practice Address - Fax:702-749-8509
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NV1356P-S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst