Healthcare Provider Details

I. General information

NPI: 1942871702
Provider Name (Legal Business Name): CPLC NEVADA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 US HIGHWAY 395 N
GARDNERVILLE NV
89410-5200
US

IV. Provider business mailing address

4070 N MARTIN L KING BLVD
N LAS VEGAS NV
89032-3214
US

V. Phone/Fax

Practice location:
  • Phone: 833-240-9017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANDRES CONTRERAS
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 602-257-0700