Provider Demographics
NPI:1386463016
Name:VARELA-ARELLANO, ISMENIA ALEXANDRA
Entity type:Individual
Prefix:
First Name:ISMENIA
Middle Name:ALEXANDRA
Last Name:VARELA-ARELLANO
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 1:3589 E GARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89061-0169
Mailing Address - Country:US
Mailing Address - Phone:702-677-9029
Mailing Address - Fax:
Practice Address - Street 1:2445 FIRE MESA ST STE 270
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9015
Practice Address - Country:US
Practice Address - Phone:702-757-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist