Healthcare Provider Details

I. General information

NPI: 1215865142
Provider Name (Legal Business Name): ANDREA CARROLL HITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 S. MARYLAND PKWY. MAIL STOP 3033
LAS VEGAS NV
89154-3033
US

IV. Provider business mailing address

4505 S MARYLAND PKWY
LAS VEGAS NV
89154-9900
US

V. Phone/Fax

Practice location:
  • Phone: 702-895-1532
  • Fax: 702-895-1530
Mailing address:
  • Phone: 702-895-1532
  • Fax: 702-895-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPT103
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: