Healthcare Provider Details

I. General information

NPI: 1376846196
Provider Name (Legal Business Name): CHAZ BREWER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 W CHEYENNE AVE
NORTH LAS VEGAS NV
89032-2484
US

IV. Provider business mailing address

675 S GREEN VALLEY PKWY # 1264
HENDERSON NV
89052-0404
US

V. Phone/Fax

Practice location:
  • Phone: 702-675-6314
  • Fax:
Mailing address:
  • Phone: 702-675-6314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12445-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: