Provider Demographics
NPI:1447261102
Name:OSTROW, JO ELLEN (LADC)
Entity type:Individual
Prefix:
First Name:JO ELLEN
Middle Name:
Last Name:OSTROW
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 E FLAMINGO RD
Mailing Address - Street 2:#2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5274
Mailing Address - Country:US
Mailing Address - Phone:702-650-0633
Mailing Address - Fax:702-650-0642
Practice Address - Street 1:1681 E FLAMINGO RD
Practice Address - Street 2:#2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5274
Practice Address - Country:US
Practice Address - Phone:702-650-0633
Practice Address - Fax:702-650-0642
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV168-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AOtherN/A