Provider Demographics
NPI:1275367955
Name:CARVALHO, MALLORY NICOLE
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:NICOLE
Last Name:CARVALHO
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:PO BOX 61151
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89006-1151
Mailing Address - Country:US
Mailing Address - Phone:702-575-8611
Mailing Address - Fax:
Practice Address - Street 1:2235 E FLAMINGO RD STE 234
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5197
Practice Address - Country:US
Practice Address - Phone:702-331-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst