| NPI | 1124745096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMI BASS Administrator 702-591-3055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2022-10-21 |