| NPI | 1699292904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA MANGUM Assistant Director Of Billing 702-385-2090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2017-08-28 |