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4455 S Pecos Rd Ste C Las Vegas NV 89121-5029 | |
| (702) 350-1430 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 4455 S Pecos Rd Ste C, Las Vegas, Nevada |
| Authorized Official Name and Position | Kelley Johnson (OWNER) |
| Authorized Official Contact | 7028108268 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3928 Bagua Ct Las Vegas NV 89129-7087 Ph: () - | 4455 S Pecos Rd Ste C Las Vegas NV 89121-5029 Ph: (702) 350-1430 |
| NPI Number | 1669031852 |
|---|---|
| Provider Enumeration Date | 06/11/2019 |
| Last Update Date | 07/18/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669031852 | NPI | - | NPPES |
| NV201911111296 | Other | NV | BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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