Individual provider Active NPI

Verna Fabella-Hicks, PH.D.

  • Clinical Psychologist
  • Las Vegas, NV
National Provider Identifier
1942349535
Registry record updated Sep 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY0537 Issued in NV
Practice address
2881 Business Park CT Ste 150
Las Vegas, NV 89128
Phone
(702) 508-2112
Fax
(702) 965-4587
NPI assigned
Feb 6, 2007
Last updated
Sep 24, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 19774 CA
Clinical Psychologist 103TC0700X PY0537 NV Primary

Addresses

Primary practice location

2881 Business Park CT Ste 150
Las Vegas, NV 89128

Mailing address

2881 Business Park CT Ste 150
Las Vegas, NV 89128-9020
Phone (702) 508-2112

Other identifiers 1

IdentifierTypeStateIssuer
100511711MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
19774CAMDClinical Psychologist
PY0537NVMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537747200000",
    "number": "1942349535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2881 BUSINESS PARK CT STE 150",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891289020",
            "telephone_number": "702-508-2112",
            "fax_number": "702-965-4587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2881 BUSINESS PARK CT STE 150",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89128",
            "telephone_number": "702-508-2112",
            "fax_number": "702-965-4587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FABELLA-HICKS",
        "first_name": "VERNA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2018-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "19774",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NV",
            "license": "PY0537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100511711",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.