Healthcare Provider Details

I. General information

NPI: 1356573901
Provider Name (Legal Business Name): NILES E STROHL MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 N 11TH ST STE 100
LAS VEGAS NV
89101-3125
US

IV. Provider business mailing address

161 W LAVAL DR
HENDERSON NV
89015-7671
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax: 702-922-6600
Mailing address:
  • Phone: 702-294-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00645
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI0147
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: