Provider Demographics
NPI:1255958799
Name:MINNICK, JOSEPH PATRICK JR (LMSW, CADC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:MINNICK
Suffix:JR
Gender:M
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 E FLAMINGO RD APT 722
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7453
Mailing Address - Country:US
Mailing Address - Phone:702-275-7227
Mailing Address - Fax:
Practice Address - Street 1:1065 E FLAMINGO RD APT 722
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7453
Practice Address - Country:US
Practice Address - Phone:170-227-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07761-C101YA0400X
NV4160-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4160-SOtherSTATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS
AZLMSW-17491OtherBOARD OF HEALTH EXAMINERS