Provider Demographics
NPI:1710323720
Name:CASILLAS-NICHOLS, CASEY RENE (MS)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:RENE
Last Name:CASILLAS-NICHOLS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W WASHINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3731
Mailing Address - Country:US
Mailing Address - Phone:702-605-5858
Mailing Address - Fax:
Practice Address - Street 1:2500 W WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3731
Practice Address - Country:US
Practice Address - Phone:027-605-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI0215101YM0800X
NV01786-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)