Provider Demographics
NPI:1740586635
Name:SIGGAL, MARY VIRGINIA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:VIRGINIA
Last Name:SIGGAL
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 1:1755 PALMS STREET
Mailing Address - Street 2:BUILDING K 221
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104
Mailing Address - Country:US
Mailing Address - Phone:702-251-3038
Mailing Address - Fax:
Practice Address - Street 1:1755 PALM ST
Practice Address - Street 2:BUILIDING K 221
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-4700
Practice Address - Country:US
Practice Address - Phone:702-251-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health