| NPI | 1659836443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROYA BEUOKAGHAEI Credentialing Supervisor 702-410-7825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2023-10-27 |