Provider Demographics
NPI:1962912097
Name:ALLISON, DONOVAN SCOTT
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:SCOTT
Last Name:ALLISON
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 1:3505 MUSTANG ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4928
Mailing Address - Country:US
Mailing Address - Phone:702-787-7771
Mailing Address - Fax:
Practice Address - Street 1:3852 PALOS VERDES ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6909
Practice Address - Country:US
Practice Address - Phone:702-787-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician