| NPI | 1609344720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIES POWELL Owner 702-378-8840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2018-11-06 |