Basic Information
| Provider Information | |||||||||
| NPI: | 1548552532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAU | ||||||||
| FirstName: | QUEENA | ||||||||
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| Credential: | B.A, QMHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 62 E SERENE AVE | ||||||||
| Address2: | UNIT 421 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891237800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087285570 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2820 W CHARLESTON BLVD # 53 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024374673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2011 | ||||||||
| LastUpdateDate: | 05/09/2011 | ||||||||
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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 | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.