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5440 W Sahara Ave Ste 202 Las Vegas NV 89146-0361 | |
| (702) 602-5106 | |
| (702) 685-7770 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 5440 W Sahara Ave Ste 202, Las Vegas, Nevada |
| Authorized Official Name and Position | Alejandra Avila Balsa (DIRECTOR) |
| Authorized Official Contact | 7028526470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5440 W Sahara Ave Ste 202 Las Vegas NV 89146-0361 Ph: (702) 602-5106 | 5440 W Sahara Ave Ste 202 Las Vegas NV 89146-0361 Ph: (702) 602-5106 |
| NPI Number | 1417646860 |
|---|---|
| Provider Enumeration Date | 05/02/2023 |
| Last Update Date | 01/13/2025 |
| Certification Date | 01/13/2025 |
| Medicare PECOS PAC ID | 9739529272 |
|---|---|
| Medicare Enrollment ID | O20240829001213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417646860 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Robert H Odell |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1013957026 PECOS PAC ID: 8022902626 Enrollment ID: I20040622001472 |
| Provider Name | Chris A Doss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861682494 PECOS PAC ID: 6800997248 Enrollment ID: I20080410000042 |
| Provider Name | Barbara G Ruscingno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184867384 PECOS PAC ID: 5294889572 Enrollment ID: I20090820000747 |
| Provider Name | Ayele E Amavigan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497921605 PECOS PAC ID: 2062725369 Enrollment ID: I20150715001997 |
| Provider Name | Krayton E Stephens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013186030 PECOS PAC ID: 0749433811 Enrollment ID: I20160404000438 |
| Provider Name | Deja Fuimaono |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497028682 PECOS PAC ID: 4385079748 Enrollment ID: I20200114001333 |
| Provider Name | Estrella P Evangelista |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114445756 PECOS PAC ID: 9739560855 Enrollment ID: I20220721000872 |
| Provider Name | Aymara Valladares |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184865289 PECOS PAC ID: 1355796244 Enrollment ID: I20240506004613 |
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