Provider Demographics
NPI:1700166980
Name:NAVARRO, TIA KAMELE EMI (MSW)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:KAMELE EMI
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5048 HIGH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2334
Mailing Address - Country:US
Mailing Address - Phone:808-652-5861
Mailing Address - Fax:
Practice Address - Street 1:5048 HIGH CREEK DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2334
Practice Address - Country:US
Practice Address - Phone:808-652-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation