Healthcare Provider Details

I. General information

NPI: 1396240388
Provider Name (Legal Business Name): MARIA MONIQUE-NICOLE MARTINEZ-QUIROS DBH, LCPC, MS, LAC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE NICOLE MARTINEZ-QUIROS DBH, LCPC, LPC, LMHC

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SILVERADO RANCH BLVD # 580
LAS VEGAS NV
89183-6203
US

IV. Provider business mailing address

450 E SILVERADO RANCH BLVD # 580
LAS VEGAS NV
89183-6203
US

V. Phone/Fax

Practice location:
  • Phone: 702-608-5160
  • Fax:
Mailing address:
  • Phone: 702-608-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number16947
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCPC-3073
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: