Provider Demographics
NPI:1427507912
Name:CARLOS, LOREN NICOLE
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:NICOLE
Last Name:CARLOS
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 1:5820 MICHAEL DEAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4422
Mailing Address - Country:US
Mailing Address - Phone:925-549-5407
Mailing Address - Fax:
Practice Address - Street 1:3909 S MARYLAND PKWY
Practice Address - Street 2:311
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7500
Practice Address - Country:US
Practice Address - Phone:888-531-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician