Provider Demographics
NPI:1871876615
Name:VANSTEENWYK, BETTY
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:VANSTEENWYK
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 1:2747 PARADISE RD UNIT 3604
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-9079
Mailing Address - Country:US
Mailing Address - Phone:805-440-9532
Mailing Address - Fax:
Practice Address - Street 1:8565 S EASTERN AVE STE 122
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2810
Practice Address - Country:US
Practice Address - Phone:805-293-1673
Practice Address - Fax:888-388-0805
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
NVPY0776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist