Provider Demographics
NPI:1790269884
Name:FROST, CANDACE (MA, LCPC, LMHC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:MA, LCPC, LMHC
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:JUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHCA
Mailing Address - Street 1:37 FOX TRACE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6282
Mailing Address - Country:US
Mailing Address - Phone:702-503-9323
Mailing Address - Fax:
Practice Address - Street 1:37 FOX TRACE CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6282
Practice Address - Country:US
Practice Address - Phone:702-503-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60884804101YM0800X
WALH60996550101YM0800X
NVCP3011-R101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health