Healthcare Provider Details

I. General information

NPI: 1124807334
Provider Name (Legal Business Name): KIERRA KALIA CHRISCO QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
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

5613 CRIMSON RIDGE DR
LAS VEGAS NV
89130-5129
US

V. Phone/Fax

Practice location:
  • Phone: 702-437-4673
  • Fax: 702-438-4673
Mailing address:
  • Phone: 580-647-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: