Healthcare Provider Details

I. General information

NPI: 1336039569
Provider Name (Legal Business Name): MALEK R BAXTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 S VALLEY VIEW BLVD STE 1
LAS VEGAS NV
89102-0145
US

IV. Provider business mailing address

3364 CHEYENNE GARDENS WAY
NORTH LAS VEGAS NV
89032-8916
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax:
Mailing address:
  • Phone: 702-906-9554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI5619
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: