Provider Demographics
NPI:1073155347
Name:UMBLES, GANADA (QBA)
Entity Type:Individual
Prefix:
First Name:GANADA
Middle Name:
Last Name:UMBLES
Suffix:
Gender:F
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 SMOKE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-3700
Mailing Address - Country:US
Mailing Address - Phone:702-790-2977
Mailing Address - Fax:725-251-6664
Practice Address - Street 1:6002 SMOKE RANCH RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3700
Practice Address - Country:US
Practice Address - Phone:702-790-2977
Practice Address - Fax:725-251-6664
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health