Basic Information
| Provider Information | |||||||||
| NPI: | 1730478819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAMA | ||||||||
| FirstName: | SOCORRO | ||||||||
| MiddleName: | GRAPILON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSGC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7768 BOSWELL CT | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891395791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105082815 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2820 W CHARLESTON BLVD # C23 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024374673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2011 | ||||||||
| LastUpdateDate: | 03/29/2011 | ||||||||
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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 | 101Y00000X | 0000087446 | NV | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.