Provider Demographics
NPI:1649815317
Name:PETSAS, ELENA (CPCI)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:PETSAS
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:CALDERON
Other - Last Name:PETSAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPCI
Mailing Address - Street 1:913 HICKORY PARK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-7595
Mailing Address - Country:US
Mailing Address - Phone:702-575-7465
Mailing Address - Fax:
Practice Address - Street 1:10655 PARK RUN DR STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4590
Practice Address - Country:US
Practice Address - Phone:702-575-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional