Healthcare Provider Details

I. General information

NPI: 1083663587
Provider Name (Legal Business Name): KAREN HASTINGS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 W WARM SPRINGS RD
HENDERSON NV
89014-7635
US

IV. Provider business mailing address

6547 BRYCE WOODLANDS ST
LAS VEGAS NV
89148-4301
US

V. Phone/Fax

Practice location:
  • Phone: 702-253-1173
  • Fax: 702-253-1468
Mailing address:
  • Phone: 702-505-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5123-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: