Provider Demographics
NPI:1699104505
Name:NEWSON, MIKE
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:NEWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 WHITNEY RANCH DR APT 1417
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2629
Mailing Address - Country:US
Mailing Address - Phone:702-879-8172
Mailing Address - Fax:
Practice Address - Street 1:625 WHITNEY RANCH DR APT 1417
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2629
Practice Address - Country:US
Practice Address - Phone:702-879-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst