Provider Demographics
NPI:1902881709
Name:SEYMORE, JUDY (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:SEYMORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34330
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-4330
Mailing Address - Country:US
Mailing Address - Phone:702-220-7633
Mailing Address - Fax:702-240-8052
Practice Address - Street 1:8240 W CHARLESTON BLVD
Practice Address - Street 2:#4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9088
Practice Address - Country:US
Practice Address - Phone:702-220-7633
Practice Address - Fax:702-240-8052
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVV36057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVQ24605Medicare UPIN
NVV36057Medicare ID - Type UnspecifiedMEDICARE