Provider Demographics
NPI:1699065524
Name:STARK-BANK, HEIDI GABRIELA (PHD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:GABRIELA
Last Name:STARK-BANK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:GABRIELA
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 60193
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89160-0193
Mailing Address - Country:US
Mailing Address - Phone:858-977-1878
Mailing Address - Fax:702-365-0602
Practice Address - Street 1:8880 W SUNSET RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5014
Practice Address - Country:US
Practice Address - Phone:702-805-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0641101YM0800X, 103TC1900X, 103TP2701X, 103TB0200X
CAPSY24810103TB0200X
CAPY0641103TB0200X
NVPY 6041103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy