Provider Demographics
NPI:1427494541
Name:MCILVAINE, MICHAELLE ANNE (BA, CADCI)
Entity type:Individual
Prefix:MS
First Name:MICHAELLE
Middle Name:ANNE
Last Name:MCILVAINE
Suffix:
Gender:F
Credentials:BA, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10258 BETHEL MILL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5203
Mailing Address - Country:US
Mailing Address - Phone:702-385-2020
Mailing Address - Fax:702-658-0480
Practice Address - Street 1:5659 DUNCAN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2811
Practice Address - Country:US
Practice Address - Phone:702-385-2020
Practice Address - Fax:702-658-0480
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)