Provider Demographics
NPI:1891133245
Name:BOLES, CYNJAYSHA LASHAE
Entity Type:Individual
Prefix:MISS
First Name:CYNJAYSHA
Middle Name:LASHAE
Last Name:BOLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 FIRE MESA ST
Mailing Address - Street 2:1990
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9014
Mailing Address - Country:US
Mailing Address - Phone:702-212-3008
Mailing Address - Fax:
Practice Address - Street 1:2445 FIRE MESA ST
Practice Address - Street 2:190
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-212-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor