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4550 W Oakey Blvd Suite 104a Las Vegas NV 89102-1581 | |
| (702) 462-0316 | |
| (702) 462-0317 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4550 W Oakey Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Mike Waller (PRESIDENT) |
| Authorized Official Contact | 7024620316 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4550 W Oakey Blvd Suite 104a Las Vegas NV 89102-1581 Ph: (702) 462-0316 | 4550 W Oakey Blvd Suite 104a Las Vegas NV 89102-1581 Ph: (702) 462-0316 |
| NPI Number | 1073966206 |
|---|---|
| Provider Enumeration Date | 07/23/2016 |
| Last Update Date | 07/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073966206 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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