1134535800 NPI number — LACY HOLLIDAY ADEYANJU LCSW

Table of content: LACY HOLLIDAY ADEYANJU LCSW (NPI 1134535800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134535800 NPI number — LACY HOLLIDAY ADEYANJU LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADEYANJU
Provider First Name:
LACY
Provider Middle Name:
HOLLIDAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLLIDAY
Provider Other First Name:
LACY
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134535800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6900 N PECOS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89086-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-791-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6900 N PECOS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89086-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-768-7407
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  8116-C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)