Provider Demographics
NPI:1609379452
Name:PRATT, MAGDALENE HOOKER
Entity type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:HOOKER
Last Name:PRATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3672 N RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3149
Mailing Address - Country:US
Mailing Address - Phone:702-685-1600
Mailing Address - Fax:702-685-1522
Practice Address - Street 1:3672 N RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3149
Practice Address - Country:US
Practice Address - Phone:702-685-1600
Practice Address - Fax:702-685-1522
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst