Healthcare Provider Details

I. General information

NPI: 1447238258
Provider Name (Legal Business Name): AMY ELLWOOD M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 FIRE MESA ST #180, FAMILY PRACTICE CENTER
LAS VEGAS NV
89128-9016
US

IV. Provider business mailing address

2410 FIRE MESA ST STE 180 FAMILY PRACTICE CENTER
LAS VEGAS NV
89128-9017
US

V. Phone/Fax

Practice location:
  • Phone: 702-992-6888
  • Fax: 702-992-6880
Mailing address:
  • Phone: 702-992-6888
  • Fax: 702-992-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01405-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: