Healthcare Provider Details

I. General information

NPI: 1780987222
Provider Name (Legal Business Name): EMIRE OLMEZTOPRAK MS, MFT, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 SPENCER ST STE A48
LAS VEGAS NV
89119-5245
US

IV. Provider business mailing address

4045 SPENCER ST STE A48
LAS VEGAS NV
89119-5245
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-8260
  • Fax: 702-209-3599
Mailing address:
  • Phone: 702-483-8260
  • Fax: 702-209-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00414
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number01237
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: