Provider Demographics
NPI:1518454404
Name:ISLAS, BIANCA SOPHIE (BS)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:SOPHIE
Last Name:ISLAS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 BURTON ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7415
Mailing Address - Country:US
Mailing Address - Phone:702-813-7886
Mailing Address - Fax:
Practice Address - Street 1:6600 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9001
Practice Address - Country:US
Practice Address - Phone:702-437-4673
Practice Address - Fax:702-438-4673
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health