Provider Demographics
NPI:1962704189
Name:THROWER, THEODIS JR
Entity type:Individual
Prefix:MR
First Name:THEODIS
Middle Name:
Last Name:THROWER
Suffix:JR
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 1:6616 NIGHT OWL BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2027
Mailing Address - Country:US
Mailing Address - Phone:702-764-0613
Mailing Address - Fax:
Practice Address - Street 1:6616 NIGHT OWL BLUFF AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2027
Practice Address - Country:US
Practice Address - Phone:702-764-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health