Unknown Individual – Clinical Social Worker, NPI 1124689690

Unknown Individual is a healthcare provider. based in Pahrump, Nevada. specializing in Clinical Social Worker. They hold a License No. 8465-C (NV). The NPI Number for Unknown Individual is 1124689690

Main info

Organization
Inactive
10 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124689690
Phone
(702) 913-5214
Address
1280 E CALVADA BLVD
Deactivation Date
17 June 2022

Doctor Profile

Medical School Name
UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Secondary Phone
7023271760
Graduation Year
2016 (10 years ago)
PAC ID
8224459995
Group Practice PAC ID
9638464746
Professional Enrollment ID
I20200604001896
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Tranquility Mental Health Center, 1280, East Calvada Boulevard, Pahrump, Nye County, Nevada, 89048, United States

    PAHRUMP, NV 890485693

    Phone: (702) 913-5214

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 89048)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9638464746View full group profile
NameSpecialtyState
MR. MICHAEL TODD MATHISEN (APRN, PMHNP-BC)
Nurse PractitionerNV
NNENNA OLUBAJO
-TX
MRS. ERICA HUNTER (LCSW)
-NV
MRS. LISA S DUBIN (LCSW)
-NV
JEREMY BRADFORD SETTERS
-NV
ALEXANDRA LIN MACY (LCSW)
-VT
MISS KAYOUA THAO
-NV

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1124689690 if you need a stable reference for Unknown Individual.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What kind of provider is Unknown Individual?
The page reflects Clinical Social Worker for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Pahrump, Nevada because that is what the record indicates for Unknown Individual.
What if Pahrump, Nevada seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.