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General NPI Number Information
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NPI Number | 1184031601
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Entity Type | Individual
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Provider Name | SAMUEL TIELEMANS
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Gender | Male
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 9418 W LAKE MEAD BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89134-8312
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Country | US
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Telephone | 702-438-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 8579 NATURE SCENE DR
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City | LAS VEGAS
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State | NV
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Zip | 89139-7048
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MI0515
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License Number State | NV
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