Provider Demographics
NPI:1396123410
Name:CAPRI DUBOIS
Entity type:Organization
Organization Name:CAPRI DUBOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:YOUTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAPRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:7753379359865-351-0079
Mailing Address - Street 1:5200 SOUTH LOS ALTOS PARKWAY
Mailing Address - Street 2:UNIT 185
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436
Mailing Address - Country:US
Mailing Address - Phone:865-351-0079
Mailing Address - Fax:
Practice Address - Street 1:5200 SOUTH LOS ALTOS PARKWAY
Practice Address - Street 2:UNIT 185
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436
Practice Address - Country:US
Practice Address - Phone:865-351-0079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health