Provider Demographics
NPI:1528479102
Name:PROSPERITY, SERENITY
Entity type:Individual
Prefix:
First Name:SERENITY
Middle Name:
Last Name:PROSPERITY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SINCERITY
Other - Middle Name:SERENITY
Other - Last Name:PROSPERITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA PSYCHOLOGY
Mailing Address - Street 1:1516 E TROPICANA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6525
Mailing Address - Country:US
Mailing Address - Phone:702-272-0987
Mailing Address - Fax:
Practice Address - Street 1:1516 E. TROPICANA
Practice Address - Street 2:
Practice Address - City:LAS VEGAS,
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-272-0987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist