| NPI | 1114763331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER IBHAWAEGBELE Manger 702-850-1614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251K00000X Public Health or Welfare | |
| 261Q00000X Clinic/Center | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QR1100X Clinic/Center, Research | |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2024-07-08 |