Provider Demographics
NPI:1215352786
Name:MANCINI, THERESA
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:MANCINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 BOULDER HWY # 1454
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-7202
Mailing Address - Country:US
Mailing Address - Phone:702-458-7071
Mailing Address - Fax:
Practice Address - Street 1:5600 BOULDER HWY # 1454
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-7202
Practice Address - Country:US
Practice Address - Phone:702-458-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health