Provider Demographics
NPI:1891294237
Name:ARCHANGEL, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:ARCHANGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E DESERT INN RD STE 214
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3206
Mailing Address - Country:US
Mailing Address - Phone:702-743-6945
Mailing Address - Fax:
Practice Address - Street 1:1700 E DESERT INN RD STE 214
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3206
Practice Address - Country:US
Practice Address - Phone:702-743-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst