Individual
MICHELLANE HAZEL MOUTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7000 SPRING MOUNTAIN RD, LAS VEGAS, NV 89117-3816
(702) 873-2400
Mailing address
9206 W RUSSELL RD # 2-212, LAS VEGAS, NV 89148-1217
(702) 290-6504
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
08/29/2017
Last updated
08/29/2017
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