Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1104196708 |
---|---|
Provider Name | Sarah Smith |
First Address | North Las Vegas, NV 89031-7917 |
Second Address | North Las Vegas, NV 89031-7917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2012 |
Last Update Date | 12/01/2012 |