Provider Demographics
NPI:1821664194
Name:BERUMEN, MICHELLE CLARISE (JD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CLARISE
Last Name:BERUMEN
Suffix:
Gender:F
Credentials:JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3067 E WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3749
Mailing Address - Country:US
Mailing Address - Phone:702-650-6508
Mailing Address - Fax:702-920-8865
Practice Address - Street 1:3067 E WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3749
Practice Address - Country:US
Practice Address - Phone:702-650-6508
Practice Address - Fax:702-920-8865
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist