Healthcare Provider Details

I. General information

NPI: 1942349535
Provider Name (Legal Business Name): VERNA FABELLA-HICKS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 BUSINESS PARK CT STE 150
LAS VEGAS NV
89128
US

IV. Provider business mailing address

2881 BUSINESS PARK CT STE 150
LAS VEGAS NV
89128-9020
US

V. Phone/Fax

Practice location:
  • Phone: 702-508-2112
  • Fax: 702-965-4587
Mailing address:
  • Phone: 702-508-2112
  • Fax: 702-965-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number19774
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0537
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: