Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Provenance Healthcare LLC

Organization Genetic Counselor (M.S.) · NPI 1316322738

Provenance Healthcare LLC is a Genetic Counselor (M.S.) in Las Vegas, Nevada. Licensed in Nevada. Registered with an NPI since 2015.

Licensed in
NV
In the registry since
2015
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5155 S Durango Dr Ste 103
Las Vegas, NV 89113-0175
Phone: (702) 478-2524
Fax: (702) 735-9074
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Genetic Counselor (M.S.) (primary) Taxonomy 170300000X · Licence OTHER (NV)

Record details

NPI number1316322738
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mark Black — Owner Operator · (702) 478-2524
NPI enumeratedJuly 27, 2015
Last updated in NPPESJuly 27, 2015
Mailing address5155 S Durango Dr Ste 103, Las Vegas, NV 89113-0175

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