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1070 W Horizon Ridge Pkwy Suite 200 Henderson NV 89012-6016 | |
| (702) 349-7309 | |
| (702) 558-0881 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1070 W Horizon Ridge Pkwy, Henderson, Nevada |
| Authorized Official Name and Position | Kathleen Lorraine Kelly (OWNER) |
| Authorized Official Contact | 7023497309 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1070 W Horizon Ridge Pkwy Suite 200 Henderson NV 89012-6016 Ph: (702) 349-7309 | 1070 W Horizon Ridge Pkwy Suite 200 Henderson NV 89012-6016 Ph: (702) 349-7309 |
| NPI Number | 1972872182 |
|---|---|
| Provider Enumeration Date | 12/16/2011 |
| Last Update Date | 09/27/2017 |
| Medicare PECOS PAC ID | 2769644129 |
|---|---|
| Medicare Enrollment ID | O20120501000189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972872182 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 201130254 (Nevada) | Primary |
| Provider Name | Kathleen L Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073664710 PECOS PAC ID: 4587741806 Enrollment ID: I20080410000131 |
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