Provider Demographics
NPI:1669273595
Name:SOON, CHANEL T
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:T
Last Name:SOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2519
Mailing Address - Country:US
Mailing Address - Phone:702-929-7217
Mailing Address - Fax:702-552-0302
Practice Address - Street 1:4225 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5486
Practice Address - Country:US
Practice Address - Phone:702-201-1956
Practice Address - Fax:702-552-0302
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health