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4660 S Eastern Ave Ste 104a Las Vegas NV 89119-6137 | |
| (702) 451-7542 | |
| (702) 450-4239 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 4660 S Eastern Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Mary Janet Roehrig (PSYCHOLOGY RESIDENT) |
| Authorized Official Contact | 7024517542 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4660 S Eastern Ave Ste 104a Las Vegas NV 89119-6137 Ph: (702) 451-7542 | 4660 S Eastern Ave Ste 104a Las Vegas NV 89119-6137 Ph: (702) 451-7542 |
| NPI Number | 1285958900 |
|---|---|
| Provider Enumeration Date | 03/24/2010 |
| Last Update Date | 12/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285958900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | PYO334 (Nevada) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | PYO334 (Nevada) | Primary |
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