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NPI Code Detail

MEDICARE: CIRCLE OF CHANGE ADOLESCENT BEHAVIORAL HEALTH COUNSELING CENTER

MEDICARE: CIRCLE OF CHANGE ADOLESCENT BEHAVIORAL HEALTH COUNSELING CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor01201-LNV
2106H00000XMarriage & Family Therapist01010NV
31041C0700XClinical Social Worker4785-CNV

General Provider Information

NPI Number : 1437385408
Entity Type Code : Organization
Provider Name (Legal Business Name) : CIRCLE OF CHANGE ADOLESCENT BEHAVIORAL HEALTH COUNSELING CENTER
Provider Business Mailing Address
First Line : 5516 S FORT APACHE RD STE 120
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-7679
Country : US
Telephone Number : 702-479-1629
Fax Number :
Provider Business Practice Location Address
First Line : 5516 S FORT APACHE RD STE 120
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-7679
Country : US
Telephone Number : 702-479-1629
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : DR. SYLVIA NASEATH
Credential : PHD, LCSW, LADC
Telephone Number : 702-479-1629
Provider Enumeration Date : 06/04/2009
Last Update Date : 06/04/2009

Similar Medicare Providers

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Practice Location Address:
5516 S FORT APACHE RD STE 130
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1679620934 — SPEECH THERAPY CENTER OF EXCELLENCE, INC.
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1669609913 — MRS. MEGAN SANDERS CADC-P
Practice Location Address:
5516 S FORT APACHE RD STE 120
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Practice Fax:
1770829061 — MRS. STACY NICOLE KISOR
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LAS VEGAS, NV
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1326575283 — KJIRSTEN BROUGHTON CCC
Practice Location Address:
5516 S FORT APACHE RD STE 130
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1487175865 — CASSANDRA TUNNEY CCC-SLP
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Directions to “CIRCLE OF CHANGE ADOLESCENT BEHAVIORAL HEALTH COUNSELING CENTER ” Practice Location

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