| NPI | 1083479380 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | SUSSAN FUNG Psychotherapy 702-773-8673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2024-02-26 |