Provider Demographics
NPI:1174996201
Name:CANTRALL, MAIMOUNA ROSE (CPC-I)
Entity type:Individual
Prefix:
First Name:MAIMOUNA
Middle Name:ROSE
Last Name:CANTRALL
Suffix:
Gender:F
Credentials:CPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 CANYON CREST DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-0533
Mailing Address - Country:US
Mailing Address - Phone:702-589-0701
Mailing Address - Fax:
Practice Address - Street 1:1600 E DESERT INN RD STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2505
Practice Address - Country:US
Practice Address - Phone:702-208-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health