| NPI | 1669039996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA SHANNON Owner 702-858-6455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2019-05-22 |