| NPI | 1356919583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIECEY BOLDEN Owner 702-677-7410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2021-06-14 |