Provider Demographics
NPI:1083912786
Name:LAZARY USHANA, MICHELLE TACASA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TACASA
Last Name:LAZARY USHANA
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 1:4262 BLUE DIAMOND RD. #102-297
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139
Mailing Address - Country:US
Mailing Address - Phone:702-339-4593
Mailing Address - Fax:187-743-5603
Practice Address - Street 1:850 E. DESERT INN RD. # D11
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:702-339-4593
Practice Address - Fax:187-743-5603
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor