Provider Demographics
NPI:1245514504
Name:TANGEMAN, NICK ALLAN (MSW, LADC)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:ALLAN
Last Name:TANGEMAN
Suffix:
Gender:M
Credentials:MSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9465 W POST RD
Mailing Address - Street 2:2044
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5782
Mailing Address - Country:US
Mailing Address - Phone:319-230-7336
Mailing Address - Fax:
Practice Address - Street 1:9465 W POST RD
Practice Address - Street 2:2044
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5782
Practice Address - Country:US
Practice Address - Phone:319-230-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6095-S104100000X
IA007004104100000X
171M00000X
NV01455-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator