Provider Demographics
NPI:1114424744
Name:VERANO, ADAM KILIONA
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:KILIONA
Last Name:VERANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 S RAINBOW BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5190
Mailing Address - Country:US
Mailing Address - Phone:702-818-3666
Mailing Address - Fax:702-405-9250
Practice Address - Street 1:2626 S RAINBOW BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5190
Practice Address - Country:US
Practice Address - Phone:702-818-3666
Practice Address - Fax:702-405-9250
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20171708172103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty