Provider Demographics
NPI:1871939959
Name:MEDDAUGH, ROBERT HOWARD (MS, MFT, LCADC, CPGC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HOWARD
Last Name:MEDDAUGH
Suffix:
Gender:M
Credentials:MS, MFT, LCADC, CPGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 NEW CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-3709
Mailing Address - Country:US
Mailing Address - Phone:702-235-9659
Mailing Address - Fax:
Practice Address - Street 1:1640 ALTA DR
Practice Address - Street 2:#4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4163
Practice Address - Country:US
Practice Address - Phone:702-474-6450
Practice Address - Fax:702-474-6463
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00125CG101Y00000X
NV00197101YA0400X
NV01022106H00000X
CA39526106H00000X
NM0145071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)