Provider Demographics
NPI:1346658523
Name:SANDSTONE PSYCHOLOGICAL PRACTICE
Entity Type:Organization
Organization Name:SANDSTONE PSYCHOLOGICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIHELIC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-738-4472
Mailing Address - Street 1:660 FINCH ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6637
Mailing Address - Country:US
Mailing Address - Phone:702-738-4472
Mailing Address - Fax:
Practice Address - Street 1:660 FINCH ISLAND AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6637
Practice Address - Country:US
Practice Address - Phone:702-738-4472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0721103TC0700X
NVPY0722103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty