Provider Demographics
NPI:1942753934
Name:MIRELES, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MIRELES
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 1:731 MALL RING CIR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6683
Mailing Address - Country:US
Mailing Address - Phone:702-547-6971
Mailing Address - Fax:
Practice Address - Street 1:731 MALL RING CIR
Practice Address - Street 2:SUITE 215
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6683
Practice Address - Country:US
Practice Address - Phone:702-547-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-16-22004103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst