Provider Demographics
NPI:1609207869
Name:SAMOYLOVA, NATALIA G (CSWI)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:G
Last Name:SAMOYLOVA
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 ARROYO CROSSING PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4085
Mailing Address - Country:US
Mailing Address - Phone:702-409-6349
Mailing Address - Fax:
Practice Address - Street 1:7455 ARROYO CROSSING PKWY # 7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4085
Practice Address - Country:US
Practice Address - Phone:702-509-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical