Provider Demographics
NPI:1619185154
Name:ORNELAS, ANDREA T (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:T
Last Name:ORNELAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7371 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1575
Mailing Address - Country:US
Mailing Address - Phone:702-533-7660
Mailing Address - Fax:702-970-2363
Practice Address - Street 1:7371 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1575
Practice Address - Country:US
Practice Address - Phone:702-533-7660
Practice Address - Fax:702-970-2363
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4704S1041C0700X
NV5237-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV110730Medicare PIN