Active NPI
David Tyler Valentine, CCMA
- Prescribing (Medical) Psychologist
- Las Vegas, NV
National Provider Identifier
1801578752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prescribing (Medical) Psychologist
- Practice address
- 6048 S Durango Dr
Las Vegas, NV 89113-1781 - Phone
- (702) 815-1550
- Fax
- (702) 815-1554
- NPI assigned
- Aug 1, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Psychiatry Physician | 2084P0802X | J5M6H2Q9 | NV | |
| Prescribing (Medical) Psychologist | 103TP0016X | Primary |
Addresses
Primary practice location
6048 S Durango Dr
Las Vegas, NV 89113-1781
Mailing address
6445 Peartree Rd
Las Vegas, NV 89108-4406
Phone (725) 249-5891
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J5M6H2Q9 | NV | MD | Addiction Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690848000000",
"number": "1801578752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6445 PEARTREE RD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891084406",
"telephone_number": "725-249-5891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6048 S DURANGO DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891131781",
"telephone_number": "702-815-1550",
"fax_number": "702-815-1554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALENTINE",
"first_name": "DAVID",
"middle_name": "TYLER",
"credential": "CCMA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-01",
"last_updated": "2023-08-01",
"certification_date": "2021-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0802X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Psychiatry",
"state": "NV",
"license": "J5M6H2Q9",
"primary": false
},
{
"code": "103TP0016X",
"taxonomy_group": "",
"desc": "Psychologist, Prescribing (Medical)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.