Provider Demographics
NPI:1780223321
Name:FLOWERS, KUSHICA K
Entity Type:Individual
Prefix:
First Name:KUSHICA
Middle Name:K
Last Name:FLOWERS
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 1:2601 S PAVILION CENTER DR UNIT 1029
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1840
Mailing Address - Country:US
Mailing Address - Phone:702-354-2171
Mailing Address - Fax:
Practice Address - Street 1:2601 S PAVILION CENTER DR UNIT 1029
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1840
Practice Address - Country:US
Practice Address - Phone:702-354-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI3101101YP2500X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2600527350Medicaid