Healthcare Provider Details

I. General information

NPI: 1891325874
Provider Name (Legal Business Name): SILVER STATE PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7341 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89117-1578
US

IV. Provider business mailing address

7341 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89117-1578
US

V. Phone/Fax

Practice location:
  • Phone: 702-268-8542
  • Fax: 702-268-8719
Mailing address:
  • Phone: 702-268-8542
  • Fax: 702-268-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. IVAN HRONEK
Title or Position: OWNER
Credential: PSYD
Phone: 702-268-8542