| NPI | 1114749967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY THORNTON Manager 702-521-7495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2024-10-31 |