Provider Demographics
NPI:1801190863
Name:NICOLE O'HARTZ L.C.S.W
Entity Type:Organization
Organization Name:NICOLE O'HARTZ L.C.S.W
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:CHUCKALINE
Authorized Official - Last Name:O'HARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-413-6360
Mailing Address - Street 1:1516 E TROPICANA AVE
Mailing Address - Street 2:290, 291
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6525
Mailing Address - Country:US
Mailing Address - Phone:702-413-6360
Mailing Address - Fax:702-413-6364
Practice Address - Street 1:1516 E TROPICANA AVE
Practice Address - Street 2:290, 291
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6525
Practice Address - Country:US
Practice Address - Phone:702-413-6360
Practice Address - Fax:702-413-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5495-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty