Provider Demographics
NPI:1821872821
Name:ORNELAS, KASSANDRA ISABEL (BEHAVIORAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:ISABEL
Last Name:ORNELAS
Suffix:
Gender:F
Credentials:BEHAVIORAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 W CENTENNIAL PKWY UNIT 3125
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1651
Mailing Address - Country:US
Mailing Address - Phone:915-253-9129
Mailing Address - Fax:
Practice Address - Street 1:5940 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2506
Practice Address - Country:US
Practice Address - Phone:888-531-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician