| NPI | 1417398009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON LANE Owner 702-885-7904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2013-07-11 |