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1401 N Green Valley Pkwy Henderson NV 89074-6198 | |
| (855) 284-7483 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1401 N Green Valley Pkwy, Henderson, Nevada |
| Authorized Official Name and Position | Anthony Centore (CEO) |
| Authorized Official Contact | 5402176461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1000 Jefferson St Ste 2c Lynchburg VA 24504-1724 Ph: (540) 217-6461 | 1401 N Green Valley Pkwy Henderson NV 89074-6198 Ph: (855) 284-7483 |
| NPI Number | 1992462097 |
|---|---|
| Provider Enumeration Date | 11/23/2021 |
| Last Update Date | 01/11/2022 |
| Certification Date | 01/11/2022 |
| Medicare PECOS PAC ID | 3173991338 |
|---|---|
| Medicare Enrollment ID | O20221118000346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992462097 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Thalia Paulina Maya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568908275 PECOS PAC ID: 1759795032 Enrollment ID: I20210127003069 |
| Provider Name | Katelyn Lopez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1083987531 PECOS PAC ID: 0042662504 Enrollment ID: I20240119002677 |
| Provider Name | Alma Spears |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1467008557 PECOS PAC ID: 5799137279 Enrollment ID: I20240119003436 |
| Provider Name | Teresa Black |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1790163194 PECOS PAC ID: 1658723044 Enrollment ID: I20240122002814 |
| Provider Name | Jason Weed |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487192209 PECOS PAC ID: 2567815095 Enrollment ID: I20240131002249 |
| Provider Name | Phuong Mai Nguyen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891083481 PECOS PAC ID: 5597100529 Enrollment ID: I20240229003373 |
| Provider Name | Mario Ortiz |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1457766453 PECOS PAC ID: 3870030232 Enrollment ID: I20240802000777 |
| Provider Name | Christine D. Camacho |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083082150 PECOS PAC ID: 4183067937 Enrollment ID: I20240807001662 |
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