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5800 W Charleston Blvd # 1073 Las Vegas NV 89146-1292 | |
| (702) 771-7124 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5800 W Charleston Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Carlotta D Winn (QUALIFIED BEHAVIORAL AIDE) |
| Authorized Official Contact | 7027717124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5800 W Charleston Blvd # 1073 Las Vegas NV 89146-1295 Ph: (702) 771-7124 | 5800 W Charleston Blvd # 1073 Las Vegas NV 89146-1292 Ph: (702) 771-7124 |
| NPI Number | 1013391556 |
|---|---|
| Provider Enumeration Date | 07/15/2015 |
| Last Update Date | 07/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013391556 | NPI | - | NPPES |
| 1601159921 | Other | NV | DMV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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