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General NPI Number Information
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NPI Number | 1326343591
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Entity Type | Individual
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Provider Name | INEZ NMN STATEN
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Gender | Female
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Dates
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Enumeration Date | 01/20/2011
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 7381 PRAIRIE FALCON RD
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City | LAS VEGAS
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State | NV
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Zip | 89128-0811
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Country | US
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Telephone | 702-468-1321
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Fax | 702-243-3757
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Provider Business Mailing Address
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Address Line | 7381 PRAIRIE FALCON ROAD SUITE 120
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City | LAS VEGAS
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State | NV
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Zip | 89128
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Country | US
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Telephone | 702-468-1321
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Fax | 702-243-3757
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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 | 00100-L
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 00102-IG
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MI0156
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 00265-S
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 131AL-5
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License Number State | NV
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