Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 00296-P | NV |
NPI | 1003193574 |
---|---|
Provider Name | Ms. Magdalena Guevara |
First Address | Las Vegas, NV 89129-4523 |
Second Address | Las Vegas, NV 89148-2435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2011 |
Last Update Date | 10/11/2011 |