Healthcare Provider Details

I. General information

NPI: 1245523836
Provider Name (Legal Business Name): ALEXIS SANDOVAL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 S VALLEY VIEW BLVD STE 1
LAS VEGAS NV
89102-0145
US

IV. Provider business mailing address

7925 MILLHOPPER AVE
LAS VEGAS NV
89128-6706
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax:
Mailing address:
  • Phone: 406-223-3904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-38823
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9299-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: