Provider Demographics
NPI:1376427922
Name:BATHULA, SRAVYA
Entity type:Individual
Prefix:
First Name:SRAVYA
Middle Name:
Last Name:BATHULA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 E AMADOR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3675
Mailing Address - Country:US
Mailing Address - Phone:505-392-3482
Mailing Address - Fax:
Practice Address - Street 1:9999 W KATIE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8347
Practice Address - Country:US
Practice Address - Phone:725-237-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician