The Center For Change Llc | |
4535 W Russell Rd Ste 15 Las Vegas NV 89118-2258 | |
(702) 368-2380 | |
(702) 368-2380 |
Full Name | The Center For Change Llc |
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Speciality | Psychologist |
Location | 4535 W Russell Rd Ste 15, Las Vegas, Nevada |
Authorized Official Name and Position | Morgan Rodriguez (MANAGER) |
Authorized Official Contact | 7029458846 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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The Center For Change Llc 4535 W Russell Rd Ste 15 Las Vegas NV 89118-2258 Ph: (702) 368-2380 | The Center For Change Llc 4535 W Russell Rd Ste 15 Las Vegas NV 89118-2258 Ph: (702) 368-2380 |
NPI Number | 1689142945 |
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Provider Enumeration Date | 11/05/2018 |
Last Update Date | 11/06/2019 |
Medicare PECOS PAC ID | 8628311651 |
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Medicare Enrollment ID | O20190515001052 |
Identifier | Type | State | Issuer |
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1689142945 | NPI | - | NPPES |
Provider Name | Martin D Fakiel |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1972787000 PECOS PAC ID: 1254319544 Enrollment ID: I20040713000226 |
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