Provider Demographics
NPI:1609492958
Name:CERVANTES TIPPIT, ANA ALICIA (LSW, CSW-INTERN)
Entity Type:Individual
Prefix:
First Name:ANA ALICIA
Middle Name:
Last Name:CERVANTES TIPPIT
Suffix:
Gender:F
Credentials:LSW, CSW-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89440-0980
Mailing Address - Country:US
Mailing Address - Phone:775-847-9311
Mailing Address - Fax:
Practice Address - Street 1:415 HWY 95A SOUTH SUITE D
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408
Practice Address - Country:US
Practice Address - Phone:775-847-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-11571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical