Provider Demographics
NPI:1821729070
Name:ESCOVAR, ANASTACIA LUCRECIA (MS)
Entity Type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:LUCRECIA
Last Name:ESCOVAR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 N EASTERN AVE STE E-3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-1594
Mailing Address - Country:US
Mailing Address - Phone:702-981-5270
Mailing Address - Fax:
Practice Address - Street 1:3964 REBECCA RAITER AVE UNIT 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-7017
Practice Address - Country:US
Practice Address - Phone:702-981-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist