| NPI | 1194304931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREY RAY Billing/Credentialing 702-279-7270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-07 |