| NPI | 1124794466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY PHELPS Owner 702-703-9666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2021-08-17 |