Healthcare Provider Details

I. General information

NPI: 1396240388
Provider Name (Legal Business Name): MARIA MONIQUE-NICOLE MARTINEZ-QUIROS DBH, LCPC, LPCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE NICOLE MARTINEZ-QUIROS DBH, MS, LPC, LCPC

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SILVERADO RANCH BLVD # 580
LAS VEGAS NV
89183-6203
US

IV. Provider business mailing address

450 E SILVERADO RANCH BLVD # 580
LAS VEGAS NV
89183-6203
US

V. Phone/Fax

Practice location:
  • Phone: 702-608-5160
  • Fax:
Mailing address:
  • Phone: 702-608-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11675-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP3073
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC5692
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-20444
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: