Provider Demographics
NPI:1821113432
Name:LUJAN, JOANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:LUJAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 LITTLE CANYON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2011
Mailing Address - Country:US
Mailing Address - Phone:702-806-5732
Mailing Address - Fax:702-664-0674
Practice Address - Street 1:2441 TECH CENTER CT
Practice Address - Street 2:SUITE 116
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0804
Practice Address - Country:US
Practice Address - Phone:702-806-5732
Practice Address - Fax:702-664-0674
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2532-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512128Medicaid
NV1151014100Medicare NSC