Provider Demographics
NPI:1871165662
Name:EDMOND, TASHERRIAN (LCPC)
Entity type:Individual
Prefix:
First Name:TASHERRIAN
Middle Name:
Last Name:EDMOND
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 W RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1224
Mailing Address - Country:US
Mailing Address - Phone:951-213-1367
Mailing Address - Fax:
Practice Address - Street 1:8945 W RUSSELL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1224
Practice Address - Country:US
Practice Address - Phone:702-476-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC15012101YM0800X
NVCP5733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health