Healthcare Provider Details

I. General information

NPI: 1881468890
Provider Name (Legal Business Name): LIFESPAN BEHAVIORAL HEALTH NEVADA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
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

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

V. Phone/Fax

Practice location:
  • Phone: 725-500-5785
  • 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
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA SUSSAL
Title or Position: OWNER
Credential:
Phone: 301-982-3437