Provider Demographics
NPI:1487391850
Name:PALENCIA, ASHLEY JANNETT
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JANNETT
Last Name:PALENCIA
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 1:552 VAN DORNUM AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-5363
Mailing Address - Country:US
Mailing Address - Phone:702-239-8781
Mailing Address - Fax:
Practice Address - Street 1:7375 S PECOS RD STE 102
Practice Address - Street 2:7375 S PECOS RD STE 102
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89120-7186
Practice Address - Country:US
Practice Address - Phone:702-900-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1706763573106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician