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11500 S Eastern Ave Ste 150 Henderson NV 89052-5576 | |
| (702) 540-7671 | |
| (702) 552-7138 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11500 S Eastern Ave Ste 150, Henderson, Nevada |
| Authorized Official Name and Position | Joanna Ghanem (MANAGING MEMBER) |
| Authorized Official Contact | 7025407671 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11500 S Eastern Ave Ste 150 Henderson NV 89052-5576 Ph: (702) 540-7671 | 11500 S Eastern Ave Ste 150 Henderson NV 89052-5576 Ph: (702) 540-7671 |
| NPI Number | 1750960043 |
|---|---|
| Provider Enumeration Date | 04/05/2021 |
| Last Update Date | 06/17/2024 |
| Certification Date | 06/17/2024 |
| Medicare PECOS PAC ID | 8224479381 |
|---|---|
| Medicare Enrollment ID | O20240507004362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750960043 | NPI | - | NPPES |
| 1601730466 | Medicaid | NV | |
| 1601730466 | Other | NV | OPEN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Armelita Lawrence |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1326516758 PECOS PAC ID: 0547701351 Enrollment ID: I20240920000105 |
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