Basic Information
| Provider Information | |||||||||
| NPI: | 1477002681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUBBS | ||||||||
| FirstName: | KAMREE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6116 CASA ANTIQUA ST | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890816609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108720505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6600 W CHARLESTON BLVD | ||||||||
| Address2: | #140 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891469001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024374673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2016 | ||||||||
| LastUpdateDate: | 09/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171W00000X | Y | Other Service Providers | Contractor |
No ID Information.