Provider Demographics
NPI:1508202631
Name:IGELEKE, EBONY S (MFT-I, CADC-I)
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:S
Last Name:IGELEKE
Suffix:
Gender:F
Credentials:MFT-I, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 ALTA DR
Mailing Address - Street 2:STE 4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4163
Mailing Address - Country:US
Mailing Address - Phone:702-474-6450
Mailing Address - Fax:702-474-6463
Practice Address - Street 1:1640 ALTA DR
Practice Address - Street 2:STE 4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4163
Practice Address - Country:US
Practice Address - Phone:702-474-6450
Practice Address - Fax:702-474-6463
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0430106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist