| NPI | 1902187735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHUNG HORTON JEFFERSON Managing Member 702-382-4061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2016-01-05 |