Provider Demographics
NPI:1851731038
Name:DAVID, ISAAC JR (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:DAVID
Suffix:JR
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:DR
Other - First Name:ISAAC
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DOCTOR
Mailing Address - Street 1:PO BOX 621637
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89162-1637
Mailing Address - Country:US
Mailing Address - Phone:702-300-2682
Mailing Address - Fax:702-802-5311
Practice Address - Street 1:3139 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3308
Practice Address - Country:US
Practice Address - Phone:702-802-5311
Practice Address - Fax:702-802-5311
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNA103TC0700X, 103TC1900X, 103T00000X
NVA/N101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1851731038Medicaid