Provider Demographics
NPI:1316287691
Name:TANESKA-PROCTOR, SONJA (PSYD, MFT)
Entity type:Individual
Prefix:DR
First Name:SONJA
Middle Name:
Last Name:TANESKA-PROCTOR
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 PAINTED MIRAGE RD STE 320A069
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4581
Mailing Address - Country:US
Mailing Address - Phone:702-523-2534
Mailing Address - Fax:858-472-9349
Practice Address - Street 1:5550 PAINTED MIRAGE RD STE 320
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4584
Practice Address - Country:US
Practice Address - Phone:702-523-2534
Practice Address - Fax:858-472-9349
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2597-R101YA0400X
CA45285101YA0400X
CAMFC 45285106H00000X
CARA832599101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)