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NPI Code Detail

MEDICARE: SHANNIN S HAGAN

MEDICARE: SHANNIN S HAGAN
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
1106S00000XBehavior TechnicianRBT-17-46790NV
2101YP2500XProfessional CounselorCI3337NV

General Provider Information

NPI Number : 1841707833
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNIN S HAGAN
Provider Business Mailing Address
First Line : 1701 W CHARLESTON BLVD STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2313
Country : US
Telephone Number : 702-251-8000
Fax Number : 702-471-0120
Provider Business Practice Location Address
First Line : 1701 W CHARLESTON BLVD STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2313
Country : US
Telephone Number : 702-251-8000
Fax Number : 702-471-0120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2017
Last Update Date : 02/06/2024

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Directions to “ SHANNIN S HAGAN ” Practice Location

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