Provider Demographics
NPI:1083050231
Name:BLIATOUT, FELICIA (BS, CADCI)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:BLIATOUT
Suffix:
Gender:F
Credentials:BS, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HARRIS SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89124-9215
Mailing Address - Country:US
Mailing Address - Phone:702-872-5382
Mailing Address - Fax:702-872-5381
Practice Address - Street 1:1200 HARRIS SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89124-9215
Practice Address - Country:US
Practice Address - Phone:702-872-5382
Practice Address - Fax:702-872-5381
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01009101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator