Provider Demographics
NPI:1518231513
Name:VEREN, JENYA (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:JENYA
Middle Name:
Last Name:VEREN
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:YEVGENIYA
Other - Middle Name:V
Other - Last Name:VERENIKINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9418 W LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-8312
Mailing Address - Country:US
Mailing Address - Phone:702-438-7800
Mailing Address - Fax:702-445-6454
Practice Address - Street 1:9418 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8312
Practice Address - Country:US
Practice Address - Phone:702-438-7800
Practice Address - Fax:702-445-6454
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist