Provider Demographics
NPI:1336487982
Name:SQUALLS, TRINA COLETTE (MBA, BSHCS)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:COLETTE
Last Name:SQUALLS
Suffix:
Gender:F
Credentials:MBA, BSHCS
Other - Prefix:MRS
Other - First Name:TRINA
Other - Middle Name:COLETTE
Other - Last Name:LASHAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBA, BSHCS
Mailing Address - Street 1:223 ZINC ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5033
Mailing Address - Country:US
Mailing Address - Phone:702-502-5459
Mailing Address - Fax:
Practice Address - Street 1:1555 E FLAMINGO RD
Practice Address - Street 2:STE# 158
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5258
Practice Address - Country:US
Practice Address - Phone:702-385-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor