Healthcare Provider Details

I. General information

NPI: 1992005128
Provider Name (Legal Business Name): MRS. LISA MARIE TORGERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S EASTERN AVE
LAS VEGAS NV
89169-3308
US

IV. Provider business mailing address

4916 HOSTETLER AVE
LAS VEGAS NV
89131-5228
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-6429
  • Fax: 702-486-6448
Mailing address:
  • Phone: 702-486-6429
  • Fax: 702-486-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: