Provider Demographics
NPI:1871995753
Name:COSLEY, CHRISTINE VICTORIA
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:VICTORIA
Last Name:COSLEY
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 1:751 N TENAYA WAY
Mailing Address - Street 2:#209
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0600
Mailing Address - Country:US
Mailing Address - Phone:702-901-1824
Mailing Address - Fax:
Practice Address - Street 1:751 N TENAYA WAY
Practice Address - Street 2:#209
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0600
Practice Address - Country:US
Practice Address - Phone:702-901-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral