Healthcare Provider Details

I. General information

NPI: 1871867739
Provider Name (Legal Business Name): SHANA STIRTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 EASTLAKE BLVD
WASHOE VALLEY NV
89704-9103
US

IV. Provider business mailing address

4160 S PECOS RD STE 17
LAS VEGAS NV
89121-5027
US

V. Phone/Fax

Practice location:
  • Phone: 775-671-5528
  • Fax:
Mailing address:
  • Phone: 702-396-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP5106
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: