| NPI | 1629779905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKSON ROSS Registered Agent 702-485-1313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2023-03-14 |