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NPI Code Detail

MEDICARE: DR. SONJA TANESKA-PROCTOR PSY.D., MFT

MEDICARE: DR. SONJA TANESKA-PROCTOR PSY.D., MFT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor2597-RNV
2101YA0400XAddiction (Substance Use Disorder) Counselor45285CA
3106H00000XMarriage & Family TherapistMFC 45285CA
4101YA0400XAddiction (Substance Use Disorder) CounselorRA832599CA

General Provider Information

NPI Number : 1316287691
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SONJA TANESKA-PROCTOR PSY.D., MFT
Provider Business Mailing Address
First Line : 5550 PAINTED MIRAGE RD STE 320A069
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-4581
Country : US
Telephone Number : 702-523-2534
Fax Number : 858-472-9349
Provider Business Practice Location Address
First Line : 5550 PAINTED MIRAGE RD STE 320
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-4584
Country : US
Telephone Number : 702-523-2534
Fax Number : 858-472-9349
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2013
Last Update Date : 07/17/2020

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