| Change Is Real Behavioral Health Services | |
|
7465 W Lake Mead Blvd Ste 103 Las Vegas NV 89128-1032 | |
| (702) 562-1293 | |
| Not Available |
| Full Name | Change Is Real Behavioral Health Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 7465 W Lake Mead Blvd Ste 103, Las Vegas, Nevada |
| Authorized Official Name and Position | Darsel Lang (PRESIDENT) |
| Authorized Official Contact | 7025621293 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Is Real Behavioral Health Services 304 S Jones Blvd Ste 2759 Las Vegas NV 89107-2623 Ph: (702) 372-1146 | Change Is Real Behavioral Health Services 7465 W Lake Mead Blvd Ste 103 Las Vegas NV 89128-1032 Ph: (702) 562-1293 |
| NPI Number | 1437789823 |
|---|---|
| Provider Enumeration Date | 01/24/2020 |
| Last Update Date | 03/19/2021 |
| Certification Date | 03/19/2021 |
| Medicare PECOS PAC ID | 1153739172 |
|---|---|
| Medicare Enrollment ID | O20210412002427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437789823 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Luke A Hatch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174075550 PECOS PAC ID: 6103230107 Enrollment ID: I20210203001334 |
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