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General NPI Number Information
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NPI Number | 1720454523
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Entity Type | Individual
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Provider Name | TIANNA NOVAK
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Gender | Female
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Dates
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Enumeration Date | 08/15/2015
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Last Update Date | 08/15/2015
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Provider Practice Location Address
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Address Line | 601 EAST ST
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City | PAHRUMP
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State | NV
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Zip | 89048-5368
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Country | US
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Telephone | 702-913-5214
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 822 1658 KETTEN RD
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City | TONOPAH
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State | NV
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Zip | 89049-0822
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Country | US
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Telephone | 913-702-4309
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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