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General NPI Number Information
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NPI Number | 1023274768
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Entity Type | Individual
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Provider Name | EDWARD L FENN LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 3005 W HORIZON RIDGE PKWY
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City | HENDERSON
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State | NV
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Zip | 89052-5029
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Country | US
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Telephone | 702-428-2870
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 E CHABLIS N
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City | PAHRUMP
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State | NV
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Zip | 89048-4841
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Country | US
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Telephone | 702-428-2870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 7358-C
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License Number State | NV
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