| NPI | 1356733174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK RUSSEL Direct Supervisor 702-912-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2015-03-03 |