Provider Demographics
NPI:1326358763
Name:SANCHEZ, ILIA T (LCSW)
Entity Type:Individual
Prefix:
First Name:ILIA
Middle Name:T
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 S DECATUR BLVD STE 25
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5857
Mailing Address - Country:US
Mailing Address - Phone:725-224-6967
Mailing Address - Fax:833-749-0357
Practice Address - Street 1:4001 S DECATUR BLVD STE 25
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5857
Practice Address - Country:US
Practice Address - Phone:725-224-6967
Practice Address - Fax:833-749-0357
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NV7114-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner