Provider Demographics
NPI:1376702555
Name:HUGHES, AMANDA DIANE (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DIANE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 ALLEN LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2229
Mailing Address - Country:US
Mailing Address - Phone:702-385-1072
Mailing Address - Fax:
Practice Address - Street 1:4455 ALLEN LN
Practice Address - Street 2:SUITE 130
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2229
Practice Address - Country:US
Practice Address - Phone:702-385-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVR07053251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health