Healthcare Provider Details

I. General information

NPI: 1083181481
Provider Name (Legal Business Name): NICOLE MARIE BURCHETT MFT-STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MARIE BURCHETT MFT-STUDENT

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7473 W. LAKE MEAD BLVD
LAS VEGAS NV
89128
US

IV. Provider business mailing address

1848 DEL MONICO WAY
NORTH LAS VEGAS NV
89031
US

V. Phone/Fax

Practice location:
  • Phone: 702-670-0043
  • Fax: 702-973-7373
Mailing address:
  • Phone: 702-355-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: