| NPI | 1629548144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANCES MALINIS Credentialing Specialist 702-410-7825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251S00000X | |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2019-03-06 |