Healthcare Provider Details

I. General information

NPI: 1386295764
Provider Name (Legal Business Name): ALLISON VIGIL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON NEIGHBORS

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10655 PARK RUN DR STE 210
LAS VEGAS NV
89144-4590
US

IV. Provider business mailing address

10566 COPPERAS COVE AVE
LAS VEGAS NV
89166-8069
US

V. Phone/Fax

Practice location:
  • Phone: 702-608-1410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4566
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: