Healthcare Provider Details

I. General information

NPI: 1255805156
Provider Name (Legal Business Name): KASIA ELIZABETH POLLOCK MS PSYCHOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S EASTERN AVE
LAS VEGAS NV
89104-2090
US

IV. Provider business mailing address

2211 SIERRA SANTIAGO
BULLHEAD CITY AZ
86442-8607
US

V. Phone/Fax

Practice location:
  • Phone: 702-587-1798
  • Fax:
Mailing address:
  • Phone: 928-219-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number320800000X
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: