Provider Demographics
NPI:1083964142
Name:LINK, MICHAEL B (QBA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:LINK
Suffix:
Gender:M
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 SYRACUSE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6141
Mailing Address - Country:US
Mailing Address - Phone:702-451-1115
Mailing Address - Fax:702-451-1115
Practice Address - Street 1:4035 SYRACUSE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6141
Practice Address - Country:US
Practice Address - Phone:702-451-1115
Practice Address - Fax:702-451-1115
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor