Healthcare Provider Details

I. General information

NPI: 1447611793
Provider Name (Legal Business Name): MRS. STEPHANIE AUCLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5426 VEGAS DR
LAS VEGAS NV
89108-2403
US

IV. Provider business mailing address

6305 PALMONA ST
NORTH LAS VEGAS NV
89031-3814
US

V. Phone/Fax

Practice location:
  • Phone: 702-806-5268
  • Fax:
Mailing address:
  • Phone: 702-349-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI0694
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: