Provider Demographics
NPI:1720429830
Name:GOMEZ, NOELLE SALVANTE
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:SALVANTE
Last Name:GOMEZ
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 1:8348 GRANITE PEAK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5415
Mailing Address - Country:US
Mailing Address - Phone:702-578-9090
Mailing Address - Fax:
Practice Address - Street 1:4525 S SANDHILL RD STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5956
Practice Address - Country:US
Practice Address - Phone:702-547-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1602199162103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst