Healthcare Provider Details

I. General information

NPI: 1912977703
Provider Name (Legal Business Name): MICHELLE GRAY HEINHOLD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9159 W FLAMINGO RD #106
LAS VEGAS NV
89147
US

IV. Provider business mailing address

9159 W FLAMINGO RD #106
LAS VEGAS NV
89147
US

V. Phone/Fax

Practice location:
  • Phone: 702-496-1135
  • Fax: 888-780-3217
Mailing address:
  • Phone: 702-496-1135
  • Fax: 888-780-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2822-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: