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General NPI Number Information
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NPI Number | 1588918759
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Entity Type | Individual
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Provider Name | TIFFANY TIVON GRASTON LCSW INTERN
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Gender | Female
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 2980 S RAINBOW BLVD STE 200-A SUITE #230
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City | LAS VEGAS
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State | NV
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Zip | 89146-6531
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Country | US
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Telephone | 702-673-7462
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Fax | 702-442-8900
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Provider Business Mailing Address
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Address Line | 8916 TORCELLO DR
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City | LAS VEGAS
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State | NV
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Zip | 89117-1104
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Country | US
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Telephone | 702-290-1604
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6052-S
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License Number State | NV
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