Provider Demographics
NPI:1376072421
Name:GOMEZ MARES, NORMA N
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:N
Last Name:GOMEZ MARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 ELIZABETHTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-2868
Mailing Address - Country:US
Mailing Address - Phone:650-737-2110
Mailing Address - Fax:
Practice Address - Street 1:3320 N BUFFALO DR STE 207
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7411
Practice Address - Country:US
Practice Address - Phone:702-659-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-11
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
RBT-18-74268106S00000X
NVMI4053106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician