| Pro-health Therapeutic & Empowerment Services Llc | |
|
2755 E Desert Inn Rd Ste 260 Las Vegas NV 89121-3690 | |
| (702) 490-9009 | |
| (866) 737-6147 |
| Full Name | Pro-health Therapeutic & Empowerment Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2755 E Desert Inn Rd Ste 260, Las Vegas, Nevada |
| Authorized Official Name and Position | Keisha Graham (OPERATIONS) |
| Authorized Official Contact | 7024909009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pro-health Therapeutic & Empowerment Services Llc 2620 S Maryland Pkwy # 14-199 Las Vegas NV 89109-8300 Ph: (702) 490-9009 | Pro-health Therapeutic & Empowerment Services Llc 2755 E Desert Inn Rd Ste 260 Las Vegas NV 89121-3690 Ph: (702) 490-9009 |
| NPI Number | 1013330695 |
|---|---|
| Provider Enumeration Date | 02/02/2014 |
| Last Update Date | 11/30/2024 |
| Medicare PECOS PAC ID | 4688979909 |
|---|---|
| Medicare Enrollment ID | O20160224002917 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013330695 | NPI | - | NPPES |
| 1015873316 | Medicaid | NV | |
| 1063780500 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Mary Grace G Gaerlan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215237110 PECOS PAC ID: 0042492910 Enrollment ID: I20110314000871 |
| Provider Name | Alysan A Sandoval |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477999647 PECOS PAC ID: 4284176314 Enrollment ID: I20240605000180 |
| Provider Name | Keisha N Graham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063780500 PECOS PAC ID: 8022313345 Enrollment ID: I20240705002209 |
| Provider Name | Tyron Mallard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275909889 PECOS PAC ID: 7911359658 Enrollment ID: I20240708002681 |
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