Healthcare Provider Details

I. General information

NPI: 1194641787
Provider Name (Legal Business Name): CHRISTOPHER PHILIP MICELI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S RANCHO DR STE A10
LAS VEGAS NV
89106-4898
US

IV. Provider business mailing address

601 S RANCHO DR STE A10
LAS VEGAS NV
89106-4898
US

V. Phone/Fax

Practice location:
  • Phone: 702-437-4673
  • Fax: 702-438-4673
Mailing address:
  • Phone: 702-437-4673
  • Fax: 702-438-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13265-M
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: