Provider Demographics
NPI:1255805156
Name:POLLOCK, KASIA ELIZABETH (MS PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:KASIA
Middle Name:ELIZABETH
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 SIERRA SANTIAGO
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8607
Mailing Address - Country:US
Mailing Address - Phone:928-219-1236
Mailing Address - Fax:
Practice Address - Street 1:1150 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2090
Practice Address - Country:US
Practice Address - Phone:702-587-1798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV320800000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health