Provider Demographics
NPI:1831566272
Name:IAN AMARANTO
Entity type:Organization
Organization Name:IAN AMARANTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QBA
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARANTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-523-5804
Mailing Address - Street 1:4760 S PECOS RD STE 100-5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4760 S PECOS RD STE 100-5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6038
Practice Address - Country:US
Practice Address - Phone:702-523-5804
Practice Address - Fax:702-855-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty