Healthcare Provider Details

I. General information

NPI: 1487115952
Provider Name (Legal Business Name): JULIA IRENE KANNARD LPC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JULIA IRENE MAGDALENO

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHADOW LN STE 106
LAS VEGAS NV
89106-4355
US

IV. Provider business mailing address

8936 SPANISH RIDGE AVE
LAS VEGAS NV
89148-1354
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-0909
  • Fax: 702-826-4757
Mailing address:
  • Phone: 702-998-2816
  • Fax: 702-998-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP1279-R
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC17860
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: