Provider Demographics
NPI:1225539554
Name:PHU-MUNS, MYCOLE WHITNEY
Entity type:Individual
Prefix:
First Name:MYCOLE
Middle Name:WHITNEY
Last Name:PHU-MUNS
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 1:714 E SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-2942
Mailing Address - Country:US
Mailing Address - Phone:702-369-8700
Mailing Address - Fax:
Practice Address - Street 1:714 E SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2942
Practice Address - Country:US
Practice Address - Phone:702-369-8700
Practice Address - Fax:702-369-8489
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07147-LCI101YA0400X
NVCI5150101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)