Provider Demographics
NPI:1720320443
Name:AGUIRRE, LILLIAN
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:
Last Name:AGUIRRE
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 1:3130 S RAINBOW BLVD
Mailing Address - Street 2:STE 304
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6232
Mailing Address - Country:US
Mailing Address - Phone:702-202-3374
Mailing Address - Fax:
Practice Address - Street 1:3130 S RAINBOW BLVD
Practice Address - Street 2:STE 304
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6232
Practice Address - Country:US
Practice Address - Phone:702-202-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1760865919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760865919Medicaid