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NPI Code Detail

MEDICARE: DR. HEATHER THANEPOHN LCSW

MEDICARE: DR. HEATHER THANEPOHN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker5419-CNV

General Provider Information

NPI Number : 1003051509
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEATHER THANEPOHN LCSW
Provider Business Mailing Address
First Line : 500 N CASINO CENTER BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-2944
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 N CASINO CENTER BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-2944
Country : US
Telephone Number : 702-383-2888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2008
Last Update Date : 01/31/2025

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