Individual
TIANNA C PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
400 SHADOW LN STE 106, LAS VEGAS, NV 89106-4355
(702) 731-0909
(702) 826-4757
Mailing address
8936 SPANISH RIDGE AVE, LAS VEGAS, NV 89148-1354
(702) 998-2816
(702) 998-2991
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
5927-S
NV
1041C0700X
Clinical Social Worker
Primary
6500
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316243504
—
NV
Enumeration date
02/04/2011
Last updated
05/06/2020
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