Healthcare Provider Details

I. General information

NPI: 1053542407
Provider Name (Legal Business Name): KIVA S HUTTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9402 W LAKE MEAD BLVD
LAS VEGAS NV
89134-8312
US

IV. Provider business mailing address

9402 W LAKE MEAD BLVD
LAS VEGAS NV
89134-8312
US

V. Phone/Fax

Practice location:
  • Phone: 702-509-0533
  • Fax: 702-445-6454
Mailing address:
  • Phone: 702-509-0533
  • Fax: 702-445-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5446-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: