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6069 S Fort Apache Rd #100 Las Vegas NV 89148-5647 | |
(702) 444-1373 | |
Not Available |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 6069 S Fort Apache Rd, Las Vegas, Nevada |
Authorized Official Name and Position | Myra Thompson (OWNER) |
Authorized Official Contact | 7024441373 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 400755 Las Vegas NV 89140-0755 Ph: () - | 6069 S Fort Apache Rd #100 Las Vegas NV 89148-5647 Ph: (702) 444-1373 |
NPI Number | 1518317759 |
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Provider Enumeration Date | 06/19/2016 |
Last Update Date | 10/15/2016 |
Identifier | Type | State | Issuer |
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1518317759 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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103T00000X | Psychologist | PY0739 (Nevada) | Secondary |
251S00000X | Community/behavioral Health | PY0739 (Nevada) | Primary |
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