Individual
MISS LEOLA FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
801 S. RANCHO DR, LAS VEGAS, NV 89106-0384
(702) 386-0254
Mailing address
801 S. RANCHO DR, LAS VEGAS, NV 89106-0384
(702) 386-0254
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
104100000X
Social Worker
—
—
Other
Enumeration date
04/21/2015
Last updated
04/05/2016
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