Provider Demographics
NPI:1083841217
Name:KEISERMAN, MICHELLE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:KEISERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 CABO LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 W HORIZON RIDGE PKWY
Practice Address - Street 2:STE 110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2706
Practice Address - Country:US
Practice Address - Phone:702-221-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-5411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical