Provider Demographics
NPI:1407191745
Name:PUENTES AGUSTIN, ALBA GRACIELA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ALBA
Middle Name:GRACIELA
Last Name:PUENTES AGUSTIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:ALBA
Other - Middle Name:GRACIELA
Other - Last Name:PUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ALBA G PUENTES
Mailing Address - Street 1:9750 W SKYE CANYON PARK DR STE 160-290
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-6623
Mailing Address - Country:US
Mailing Address - Phone:702-570-8967
Mailing Address - Fax:
Practice Address - Street 1:9750 W SKYE CANYON PARK DR STE 160-290
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-6623
Practice Address - Country:US
Practice Address - Phone:702-570-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106854106H00000X
390200000X
NV2557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program