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2780 S Jones Blvd Ste 100a Las Vegas NV 89146-5625 | |
| (808) 557-6092 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 2780 S Jones Blvd Ste 100a, Las Vegas, Nevada |
| Authorized Official Name and Position | Chadwick Phillips (MANAGING MEMBER) |
| Authorized Official Contact | 7029350025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2780 S Jones Blvd Ste 115d Las Vegas NV 89146-5625 Ph: (702) 935-0025 | 2780 S Jones Blvd Ste 100a Las Vegas NV 89146-5625 Ph: (808) 557-6092 |
| NPI Number | 1548771454 |
|---|---|
| Provider Enumeration Date | 10/18/2017 |
| Last Update Date | 08/29/2023 |
| Certification Date | 08/29/2023 |
| Medicare PECOS PAC ID | 4981969771 |
|---|---|
| Medicare Enrollment ID | O20180529000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548771454 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Kelly Michelle Campbell-kiser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669763090 PECOS PAC ID: 5496933285 Enrollment ID: I20151021001477 |
| Provider Name | Anthony F Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407046535 PECOS PAC ID: 0749557544 Enrollment ID: I20170809001959 |
| Provider Name | Sondra Regina Bryant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518177310 PECOS PAC ID: 3971930512 Enrollment ID: I20200220003119 |
| Provider Name | Cristen Marie Seiders |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588238570 PECOS PAC ID: 6901206846 Enrollment ID: I20210614002830 |
| Provider Name | Alexandra Nicole Givens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245689116 PECOS PAC ID: 6103272232 Enrollment ID: I20231026001201 |
| Provider Name | Jessica Kay Halling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316452139 PECOS PAC ID: 7416481585 Enrollment ID: I20241112002116 |
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