Provider Demographics
NPI:1396172912
Name:CASELY-WILBERFORCE, ANITA ELIZABETH
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:ELIZABETH
Last Name:CASELY-WILBERFORCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANITA
Other - Middle Name:ELIZABETH
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 E. HARMON AVE
Mailing Address - Street 2:APT 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169
Mailing Address - Country:US
Mailing Address - Phone:615-290-1068
Mailing Address - Fax:
Practice Address - Street 1:303 E. HARMON AVE
Practice Address - Street 2:APT 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169
Practice Address - Country:US
Practice Address - Phone:615-290-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst