Provider Demographics
NPI:1992944623
Name:MORISSETTE, KATHI (MCP)
Entity type:Individual
Prefix:
First Name:KATHI
Middle Name:
Last Name:MORISSETTE
Suffix:
Gender:F
Credentials:MCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N EASTERN AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2883
Mailing Address - Country:US
Mailing Address - Phone:702-598-2020
Mailing Address - Fax:702-598-2018
Practice Address - Street 1:730 N EASTERN AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2883
Practice Address - Country:US
Practice Address - Phone:702-598-2020
Practice Address - Fax:702-598-2018
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01041-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV01041-LOtherSTATE OF NEVADA BOARD OF EXAMINER FOR ALCOHOL AND DRUG ABUSE COUNSELORS