Healthcare Provider Details

I. General information

NPI: 1518301357
Provider Name (Legal Business Name): CHERISSE ANN MCCULLERS COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 E FLAMINGO RD
LAS VEGAS NV
89121-5205
US

IV. Provider business mailing address

2832 E FLAMINGO RD
LAS VEGAS NV
89121-5205
US

V. Phone/Fax

Practice location:
  • Phone: 702-423-3436
  • Fax:
Mailing address:
  • Phone: 702-423-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number0000076176
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: