Basic Information
| Provider Information | |||||||||
| NPI: | 1053770289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATKINSON | ||||||||
| FirstName: | TIARRA | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3360 MOON ECLIPSE ST | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890328233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027044942 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 888 W BONNEVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891060100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024836000 | ||||||||
| FaxNumber: | 7024836010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2016 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 7578-C | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.