Provider Demographics
NPI:1285946152
Name:SARGENT, MARY KAY
Entity type:Individual
Prefix:MS
First Name:MARY KAY
Middle Name:
Last Name:SARGENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY KAY
Other - Middle Name:
Other - Last Name:SARGENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:6765 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE #130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2003
Mailing Address - Country:US
Mailing Address - Phone:702-285-6157
Mailing Address - Fax:702-631-9976
Practice Address - Street 1:6765 W CHARLESTON BLVD
Practice Address - Street 2:SUITE #130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2003
Practice Address - Country:US
Practice Address - Phone:702-285-6157
Practice Address - Fax:702-631-9976
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0204106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist