Provider Demographics
NPI:1205250933
Name:STAGE, MICHEAL
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:
Last Name:STAGE
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 1:3406 CINNAMON CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3520
Mailing Address - Country:US
Mailing Address - Phone:702-994-8501
Mailing Address - Fax:
Practice Address - Street 1:3406 CINNAMON CREEK AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3520
Practice Address - Country:US
Practice Address - Phone:702-994-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health