Aysan Annelise Sandoval, MS NCC CPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CP3048 Issued in NV

Practice address

3376 S Eastern Ave Ste 160
Las Vegas, NV 89169-3388

Phone

(702) 490-9009

Fax

(866) 737-6147

NPI assigned

May 15, 2013

Last updated

Oct 13, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pro-Health Therapeutic & Empowerment Services LLC

  dba Pro-Health Wellness Group

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1013330695
  Medicare reassignment NPD
• Pro-Health Therapeutic & Empowerment Services LLC

  dba ProHealth Therapeutic & Empowerment Services

  • General Practice Physician
  • Las Vegas, NV
  • NPI 1053967265
  NPD (past)
• Pro-Health Therapeutic & Empowerment Services LLC

  • Community Health Worker
  • Las Vegas, NV
  • NPI 1194645598
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1477999647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4017 KEASBERRY AVE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890816693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3376 S EASTERN AVE STE 160",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693388",
            "telephone_number": "702-490-9009",
            "fax_number": "866-737-6147"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8685 S Eastern Ave",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891232839",
            "country_code": "US",
            "telephone_number": "702-754-0807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "AYSAN",
        "middle_name": "ANNELISE",
        "credential": "MS NCC CPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-15",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NV",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NV",
            "license": "CP3048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Marie Heather Sandoval-Lunn
• Jose Sandoval-Ponce
• Agueda Sandoval
• Alexis Sandoval, LCSW
• Alvic Sandoval
• Brenda Sandoval
• Damaris Sandoval
• Daniel Sandoval
• Dolores Sandoval
• Esteban Sandoval

• Professional Counselor in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Professional Counselor in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.