Provider Demographics
NPI:1609211259
Name:NEUBAUER, TIARA MARIE
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:MARIE
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5231
Mailing Address - Country:US
Mailing Address - Phone:702-207-9358
Mailing Address - Fax:
Practice Address - Street 1:2920 S JONES BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5394
Practice Address - Country:US
Practice Address - Phone:702-776-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical