Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1992046213 |
---|---|
Provider Name | Michelle Villeral |
First Address | Las Vegas, NV 89149 |
Second Address | Las Vegas, NV 89149-4412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2013 |
Last Update Date | 12/03/2013 |