Healthcare Provider Details

I. General information

NPI: 1407284060
Provider Name (Legal Business Name): MICHELE J FLORES QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE FLORES-JOHNSON

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 W DESERT INN RD
LAS VEGAS NV
89102-7116
US

IV. Provider business mailing address

4623 W DESERT INN RD
LAS VEGAS NV
89102-7116
US

V. Phone/Fax

Practice location:
  • Phone: 702-410-9629
  • Fax:
Mailing address:
  • Phone: 702-410-9629
  • Fax: 702-410-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI5590
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: