Individual
MRS. CHANELL MJ ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHP
Contact information
Practice address
2400 N TENAYA WAY, LAS VEGAS, NV 89128-0420
(702) 379-5927
Mailing address
4780 W ANN RD STE 375, NORTH LAS VEGAS, NV 89031-3470
(702) 550-9323
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
23-QMHA-I-004113
—
225400000X
Rehabilitation Practitioner
21-QMHA-R1929
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23-QMHA-I-004113
MHACBO
—
Enumeration date
08/05/2022
Last updated
02/07/2024
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