Healthcare Provider Details

I. General information

NPI: 1619006129
Provider Name (Legal Business Name): SETHLIN HOOKSTRA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/15/2014
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: 702-441-4483
  • Fax: 702-248-1339
Mailing address:
  • Phone: 702-248-8866
  • Fax: 702-248-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: