Provider Demographics
NPI:1720379779
Name:SIMPSON, ETHEL LEONA (BS)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:LEONA
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:CHYNA
Other - Middle Name:LEONA
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:2820 W CHARLESTON BLVD
Mailing Address - Street 2:C23
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1942
Mailing Address - Country:US
Mailing Address - Phone:702-437-4673
Mailing Address - Fax:
Practice Address - Street 1:2820 W CHARLESTON BLVD
Practice Address - Street 2:C23
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1942
Practice Address - Country:US
Practice Address - Phone:702-437-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health