Healthcare Provider Details

I. General information

NPI: 1821408659
Provider Name (Legal Business Name): A NEW START HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 E BONNEVILLE AVE UNIT 123
LAS VEGAS NV
89101-6625
US

IV. Provider business mailing address

PO BOX 72052
LAS VEGAS NV
89170-2052
US

V. Phone/Fax

Practice location:
  • Phone: 702-882-5969
  • Fax:
Mailing address:
  • Phone: 702-882-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1164832390
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARICRUZ RAND
Title or Position: ADMIN
Credential:
Phone: 702-882-5969