Healthcare Provider Details

I. General information

NPI: 1578001871
Provider Name (Legal Business Name): COLLEEN PAUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S JONES BLVD
LAS VEGAS NV
89146-5306
US

IV. Provider business mailing address

2740 S JONES BLVD
LAS VEGAS NV
89146-5306
US

V. Phone/Fax

Practice location:
  • Phone: 702-248-8866
  • Fax: 702-248-9640
Mailing address:
  • Phone: 702-248-8866
  • Fax: 702-248-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: