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General NPI Number Information
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NPI Number | 1629308036
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Entity Type | Individual
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Provider Name | ALYSSA FAITH VENTURA BRUNKEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 5043 BELL LOOP
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City | LAS VEGAS
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State | NV
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Zip | 89115-2940
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Country | US
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Telephone | 702-738-9780
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Fax |
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Provider Business Mailing Address
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Address Line | 11237 GALLERY ECHO ST
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City | LAS VEGAS
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State | NV
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Zip | 89141-6052
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Country | US
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Telephone | 702-738-9780
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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