Healthcare Provider Details

I. General information

NPI: 1114547726
Provider Name (Legal Business Name): LIFESPAN BEHAVIORAL HEALTH NEVADA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W HORIZON RIDGE PKWY STE 110
HENDERSON NV
89052-2707
US

IV. Provider business mailing address

2505 ANTHEM VILLAGE DR STE E-508
HENDERSON NV
89052-5505
US

V. Phone/Fax

Practice location:
  • Phone: 702-544-1776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN REIDY
Title or Position: OFFICE ADMIN
Credential:
Phone: 800-819-7570