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Individual

LAKETA GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7320 S RAINBOW BLVD # 102-192, LAS VEGAS, NV 89139-0406
(702) 625-1079
Mailing address
7320 S RAINBOW BLVD # 102-192, LAS VEGAS, NV 89139-0406
(702) 625-1079

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
05/18/2023
Last updated
06/10/2023
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