Provider Demographics
NPI:1194619619
Name:KIETRE MEDICAL AND BEHAVIORAL CLINIC
Entity type:Organization
Organization Name:KIETRE MEDICAL AND BEHAVIORAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUSSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP, FNP
Authorized Official - Phone:702-670-0280
Mailing Address - Street 1:17 SUMMIT CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-6856
Mailing Address - Country:US
Mailing Address - Phone:702-670-0280
Mailing Address - Fax:
Practice Address - Street 1:17 SUMMIT CREEK AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-6856
Practice Address - Country:US
Practice Address - Phone:702-670-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty