Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1114290616 |
---|---|
Provider Name | Shayla Wilson |
First Address | N Las Vegas, NV 89081-6661 |
Second Address | Las Vegas, NV 89146-1126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 11/07/2014 |