Provider Demographics
NPI:1730484080
Name:PILI, MYRNA VICTORIA TUSAGA (MBA)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:VICTORIA TUSAGA
Last Name:PILI
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8752 HARVEST VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7682
Mailing Address - Country:US
Mailing Address - Phone:702-569-4455
Mailing Address - Fax:
Practice Address - Street 1:8752 HARVEST VALLEY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7682
Practice Address - Country:US
Practice Address - Phone:702-569-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor