Provider Demographics
NPI:1396555397
Name:EARL, CHRISTIAN CHARLENE
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:CHARLENE
Last Name:EARL
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 1:10697 W CENTENNIAL PKWY APT 2149
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-1513
Mailing Address - Country:US
Mailing Address - Phone:702-355-3553
Mailing Address - Fax:
Practice Address - Street 1:1607 E WINDMILL LN STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1910
Practice Address - Country:US
Practice Address - Phone:702-757-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical