Provider Demographics
NPI:1003984774
Name:MISHALOW, JOEL (PHD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:MISHALOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 WEST ROCHELLE AVE
Mailing Address - Street 2:#300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103
Mailing Address - Country:US
Mailing Address - Phone:702-252-3535
Mailing Address - Fax:702-362-1357
Practice Address - Street 1:6000 WEST ROCHELLE AVE
Practice Address - Street 2:#300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103
Practice Address - Country:US
Practice Address - Phone:702-252-3535
Practice Address - Fax:702-362-1357
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPYO344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical