Individual
CORY VANDERHILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2150 N TENAYA WAY, 1212, LAS VEGAS, NV 89128-0402
(702) 412-5566
Mailing address
2150 N TENAYA WAY, APT# 1212, LAS VEGAS, NV 89128-0402
(702) 412-5566
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000143106
—
NV
01
—
1500151870
HEALTH PLAN OF NEVADA
NV
Enumeration date
03/17/2017
Last updated
03/17/2017
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