Healthcare Provider Details

I. General information

NPI: 1538724216
Provider Name (Legal Business Name): TCOYL PLUS ONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 S EASTERN AVE STE 110
HENDERSON NV
89052-6200
US

IV. Provider business mailing address

11201 S EASTERN AVE STE 110
HENDERSON NV
89052-6200
US

V. Phone/Fax

Practice location:
  • Phone: 702-534-4244
  • Fax: 725-605-6792
Mailing address:
  • Phone: 702-534-4244
  • Fax: 725-605-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IRENE BENLIRO
Title or Position: MEDICAL DIRECTOR
Credential: APRN
Phone: 702-480-8723