Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103K00000X | Behavior Analyst |
NPI | 1013353226 |
---|---|
Provider Name | Lonell Nolen |
First Address | Henderson, NV 89074-8720 |
Second Address | Henderson, NV 89074-8720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 24/04/2018 |