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801 S Rancho Dr Ste A2 Las Vegas NV 89106-3870 | |
| (702) 805-5360 | |
| (309) 663-2995 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 801 S Rancho Dr Ste A2, Las Vegas, Nevada |
| Authorized Official Name and Position | Melanie Gray (BILLING SPECIALISTS) |
| Authorized Official Contact | 2535271571 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 8204 Pasadena CA 91109-8204 Ph: () - | 801 S Rancho Dr Ste A2 Las Vegas NV 89106-3870 Ph: (702) 805-5360 |
| NPI Number | 1003473448 |
|---|---|
| Provider Enumeration Date | 05/21/2019 |
| Last Update Date | 01/25/2023 |
| Certification Date | 01/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003473448 | NPI | - | NPPES |
| PY0777 | Other | NV | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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