Healthcare Provider Details

I. General information

NPI: 1548154842
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SOLUTIONS OF WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PASEO VERDE PKWY STE 190
HENDERSON NV
89052-2703
US

IV. Provider business mailing address

2200 PASEO VERDE PKWY STE 190
HENDERSON NV
89052-2703
US

V. Phone/Fax

Practice location:
  • Phone: 725-214-4666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JULIAN CORTEZ
Title or Position: LEAD CREDENTIALING SPECIALIST
Credential:
Phone: 702-473-9841