| Light Behavioral Health Center | |
|
2110 E Flamingo Rd Ste 205 Las Vegas NV 89119-5192 | |
| (702) 620-5105 | |
| Not Available |
| Full Name | Light Behavioral Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2110 E Flamingo Rd Ste 205, Las Vegas, Nevada |
| Authorized Official Name and Position | Deborah Bernal Perez (MANAGING MEMBER) |
| Authorized Official Contact | 7022728619 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Behavioral Health Center 1912 Magnolia Dr Henderson NV 89014-5192 Ph: () - | Light Behavioral Health Center 2110 E Flamingo Rd Ste 205 Las Vegas NV 89119-5192 Ph: (702) 620-5105 |
| NPI Number | 1780151415 |
|---|---|
| Provider Enumeration Date | 10/31/2018 |
| Last Update Date | 09/20/2019 |
| Medicare PECOS PAC ID | 6901139161 |
|---|---|
| Medicare Enrollment ID | O20190604001135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780151415 | NPI | - | NPPES |
| Provider Name | Martin D Fakiel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972787000 PECOS PAC ID: 1254319544 Enrollment ID: I20040713000226 |
| Provider Name | Elsa I Villalobos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124032214 PECOS PAC ID: 6406921550 Enrollment ID: I20080825000264 |
| Provider Name | Ansy P John |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265660047 PECOS PAC ID: 6901933373 Enrollment ID: I20100416000707 |
| Provider Name | Yolanda Proulx-vigil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891867107 PECOS PAC ID: 6103109061 Enrollment ID: I20170220001857 |
| Provider Name | Roberto Ruiz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134337652 PECOS PAC ID: 6608136874 Enrollment ID: I20180207003002 |
| Provider Name | Jollene V Stiles-bradsher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780953844 PECOS PAC ID: 5698022879 Enrollment ID: I20180718003865 |
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