Healthcare Provider Details

I. General information

NPI: 1477002681
Provider Name (Legal Business Name): KAMREE STUBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON BLVD #140
LAS VEGAS NV
89146-9001
US

IV. Provider business mailing address

6116 CASA ANTIQUA ST
NORTH LAS VEGAS NV
89081-6609
US

V. Phone/Fax

Practice location:
  • Phone: 702-437-4673
  • Fax:
Mailing address:
  • Phone: 510-872-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: