Provider Demographics
NPI:1508176769
Name:LOUIS, TIANA MAKAIWA PARK (LCADC, CPC-INTERN)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:MAKAIWA PARK
Last Name:LOUIS
Suffix:
Gender:F
Credentials:LCADC, CPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4313
Mailing Address - Country:US
Mailing Address - Phone:702-385-3330
Mailing Address - Fax:702-385-5519
Practice Address - Street 1:401 S MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4313
Practice Address - Country:US
Practice Address - Phone:702-385-3330
Practice Address - Fax:702-385-5519
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI0047101YP2500X
NV00161-LC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)