Provider Demographics
NPI:1639448673
Name:AVALOS, YESENIA (LADC, CPGC)
Entity Type:Individual
Prefix:MISS
First Name:YESENIA
Middle Name:
Last Name:AVALOS
Suffix:
Gender:F
Credentials:LADC, CPGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N EASTERN AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2883
Mailing Address - Country:US
Mailing Address - Phone:702-598-2020
Mailing Address - Fax:702-598-2018
Practice Address - Street 1:730 N EASTERN AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2883
Practice Address - Country:US
Practice Address - Phone:702-598-2020
Practice Address - Fax:702-598-2018
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00130251S00000X
NV01245251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health