Healthcare Provider Details

I. General information

NPI: 1700190428
Provider Name (Legal Business Name): KARLENE ULIBARRI, DBA, BOUNTIFUL FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 WYOMING ST
BOULDER CITY NV
89005-2822
US

IV. Provider business mailing address

303 WYOMING ST
BOULDER CITY NV
89005-2822
US

V. Phone/Fax

Practice location:
  • Phone: 702-927-9271
  • Fax: 702-253-1969
Mailing address:
  • Phone: 702-927-9271
  • Fax: 702-253-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 0498
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number5114S
License Number StateNV

VIII. Authorized Official

Name: KARLENE MARIE ULIBARRI
Title or Position: DIRECTOR
Credential: LSW
Phone: 702-927-9271