Provider Demographics
NPI:1669823209
Name:TRIPOLI, MONA LISA
Entity Type:Individual
Prefix:
First Name:MONA LISA
Middle Name:
Last Name:TRIPOLI
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 1:4701 E. SAHARA AVE
Mailing Address - Street 2:BUILDING 10, APT 137 USE MAILBOX NEXT TO LEASING OFFICE
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104
Mailing Address - Country:US
Mailing Address - Phone:702-287-7713
Mailing Address - Fax:
Practice Address - Street 1:3355 SPRING MOUNTAIN RD
Practice Address - Street 2:SUITE 48
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8639
Practice Address - Country:US
Practice Address - Phone:702-287-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health