Healthcare Provider Details

I. General information

NPI: 1902880677
Provider Name (Legal Business Name): ALLAN EDWARD BIGTAS JR. MSW, LCSW, BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N BLDG 1300
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

4700 LAS VEGAS BLVD N BLDG 1300
NELLIS AFB NV
89191-6600
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2369
  • Fax: 702-653-2369
Mailing address:
  • Phone: 702-653-2369
  • Fax: 702-653-2369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3263
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: