Healthcare Provider Details

I. General information

NPI: 1306237490
Provider Name (Legal Business Name): CLINT EMERY BANKS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 03/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S VALLEY VIEW BLVD STE 6
LAS VEGAS NV
89102
US

IV. Provider business mailing address

680 BOLLONS ISLAND ST
HENDERSON NV
89002-0965
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax: 702-922-6600
Mailing address:
  • Phone: 702-682-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7581-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: