Basic Information
| Provider Information | |||||||||
| NPI: | 1386154375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITMIRE | ||||||||
| FirstName: | SASHIA | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | QUALIFIED BEHAVIORAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891011001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023834044 | ||||||||
| FaxNumber: | 7023838331 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891011001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023834044 | ||||||||
| FaxNumber: | 7023838331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2017 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 106S00000X | Y |
No ID Information.