Healthcare Provider Details

I. General information

NPI: 1154808996
Provider Name (Legal Business Name): AMAN TESFAYE ACQUAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 WHITNEY MESA DR
HENDERSON NV
89014-2056
US

IV. Provider business mailing address

2855 N WALNUT RD APT 401
LAS VEGAS NV
89115-3234
US

V. Phone/Fax

Practice location:
  • Phone: 310-894-2968
  • Fax:
Mailing address:
  • Phone: 310-894-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: