| NPI | 1366058067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA POOLE Credentialing Specialist 702-278-3919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2021-10-15 |