Healthcare Provider Details

I. General information

NPI: 1528700473
Provider Name (Legal Business Name): TARYN DANIELLE HICKS CSW-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E TROPICANA AVE STE 580
LAS VEGAS NV
89119-6517
US

IV. Provider business mailing address

8528 MYRSINE CT
LAS VEGAS NV
89149-0222
US

V. Phone/Fax

Practice location:
  • Phone: 702-898-5311
  • Fax: 702-222-3275
Mailing address:
  • Phone: 702-580-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12114-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: