Provider Demographics
NPI:1255896106
Name:ALONSO, ANGEL R (LMFT-I)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:R
Last Name:ALONSO
Suffix:
Gender:M
Credentials:LMFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5971 DRONBERGER WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5034
Mailing Address - Country:US
Mailing Address - Phone:702-203-5028
Mailing Address - Fax:
Practice Address - Street 1:2920 N GREEN VALLEY PKWY BLDG 3-321
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0406
Practice Address - Country:US
Practice Address - Phone:702-508-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI1120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist