Individual
MR. MARLON LEON BLANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSE CLINICAL SOC
Contact information
Practice address
6655 W SAHARA AVE STE A112, LAS VEGAS, NV 89146-2805
(702) 462-1813
Mailing address
6655 W SAHARA AVE A112, LAS VEGAS, NV 89146
(702) 462-1813
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7112-C
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629139696
TRICARE WEST
NV
05
—
1629139696
—
NV
Enumeration date
12/13/2006
Last updated
12/11/2018
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