Provider Demographics
NPI:1053850636
Name:SOUCY, ROBERT (LCADC, LAC, ICAADC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SOUCY
Suffix:
Gender:M
Credentials:LCADC, LAC, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8732 AUTUMN VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7618
Mailing Address - Country:US
Mailing Address - Phone:505-210-6098
Mailing Address - Fax:
Practice Address - Street 1:2121 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-382-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00689-C101YA0400X
CARA8750817101YA0400X
NMCAD0196351101YA0400X
NMT-CTL0193941101YM0800X
NV0529-LC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health