Provider Demographics
NPI:1801320940
Name:NOOTENBOOM, KANA AOKI (MFT)
Entity type:Individual
Prefix:
First Name:KANA
Middle Name:AOKI
Last Name:NOOTENBOOM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 MACDONALD RANCH DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-7247
Mailing Address - Country:US
Mailing Address - Phone:702-530-1255
Mailing Address - Fax:
Practice Address - Street 1:2637 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4834
Practice Address - Country:US
Practice Address - Phone:702-530-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist