MEDICARE: TIANNA C PENA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	5927-S	NV
2	1041C0700X	Clinical Social Worker	6500	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316243504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANNA C PENA LCSW

Provider Business Mailing Address
First Line	:	8936 SPANISH RIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1354
Country	:	US
Telephone Number	:	702-998-2816
Fax Number	:	702-998-2991

Provider Business Practice Location Address
First Line	:	400 SHADOW LN STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4355
Country	:	US
Telephone Number	:	702-731-0909
Fax Number	:	702-826-4757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	05/06/2020

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Directions to “ TIANNA C PENA LCSW” Practice Location

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