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6171 W Charleston Blvd Bldg 7 Las Vegas NV 89146-1126 | |
| (702) 486-6166 | |
| (702) 486-7759 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 6171 W Charleston Blvd Bldg 7, Las Vegas, Nevada |
| Authorized Official Name and Position | Sandra Stone (MANAGEMENT ANALYST 3) |
| Authorized Official Contact | 7024868226 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1350 S Jones Blvd Ste 220 Las Vegas NV 89146-1233 Ph: (702) 486-8226 | 6171 W Charleston Blvd Bldg 7 Las Vegas NV 89146-1126 Ph: (702) 486-6166 |
| NPI Number | 1568539914 |
|---|---|
| Provider Enumeration Date | 11/29/2006 |
| Last Update Date | 01/17/2024 |
| Certification Date | 01/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568539914 | NPI | - | NPPES |
| 100507998 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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