Healthcare Provider Details

I. General information

NPI: 1891330809
Provider Name (Legal Business Name): REYMON ULAN CPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2298 W HORIZON RIDGE PKWY STE 201
HENDERSON NV
89052-2698
US

IV. Provider business mailing address

2298 W HORIZON RIDGE PKWY STE 201
HENDERSON NV
89052-2698
US

V. Phone/Fax

Practice location:
  • Phone: 702-417-5518
  • Fax: 702-242-5252
Mailing address:
  • Phone: 702-608-3239
  • Fax: 702-242-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI715
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: