| Lifespan Behavioral Health Nevada Pc | |
|
2505 Anthem Village Dr Ste E-508 Henderson NV 89052-5505 | |
| (702) 544-1776 | |
| Not Available |
| Full Name | Lifespan Behavioral Health Nevada Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2505 Anthem Village Dr Ste E-508, Henderson, Nevada |
| Authorized Official Name and Position | Carolyn Reidy (OFFICE ADMIN) |
| Authorized Official Contact | 8008197570 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan Behavioral Health Nevada Pc 2505 Anthem Village Dr Ste E-508 Henderson NV 89052-5505 Ph: () - | Lifespan Behavioral Health Nevada Pc 2505 Anthem Village Dr Ste E-508 Henderson NV 89052-5505 Ph: (702) 544-1776 |
| NPI Number | 1114547726 |
|---|---|
| Provider Enumeration Date | 04/23/2020 |
| Last Update Date | 05/11/2022 |
| Certification Date | 05/11/2022 |
| Medicare PECOS PAC ID | 0749611275 |
|---|---|
| Medicare Enrollment ID | O20200515001900 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114547726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Secondary |
| Provider Name | Joshua B Sussal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922212174 PECOS PAC ID: 6204936446 Enrollment ID: I20200515002030 |
| Provider Name | John Dahunsi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386378735 PECOS PAC ID: 3779951900 Enrollment ID: I20230328000913 |
| Provider Name | Derek Joseph Chamberlain |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841564978 PECOS PAC ID: 9234576315 Enrollment ID: I20240325003232 |
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