Individual
TRACY WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFCT; MFT
Contact information
Practice address
3940 N MARTIN LUTHER KING BOULEVARD, N LAS VEGAS, NV 89032
(702) 731-0909
(702) 724-1978
Mailing address
8936 SPANISH RIDGE AVE, LAS VEGAS, NV 89148-1354
(702) 998-2816
(702) 998-2991
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
01200
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033421748
—
NV
Enumeration date
07/10/2010
Last updated
07/31/2020
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