| NPI | 1013424100 |
|---|---|
| Other Name | LEGAL BUSINESS NAME |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JEIDER Owner 702-350-2906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2022-03-17 |