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General NPI Number Information
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NPI Number | 1558098962
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Entity Type | Individual
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Provider Name | CHANELL MJ ALLEN QMHP
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Gender | Female
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 2400 N TENAYA WAY
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City | LAS VEGAS
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State | NV
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Zip | 89128-0420
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Country | US
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Telephone | 702-379-5927
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Fax |
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Provider Business Mailing Address
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Address Line | 4780 W ANN RD STE 375
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-3470
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Country | US
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Telephone | 702-550-9323
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 21-QMHA-R1929
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License Number State | OR
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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 | 23-QMHA-I-004113
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License Number State |
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