Healthcare Provider Details

I. General information

NPI: 1245621622
Provider Name (Legal Business Name): NEVADA INTEGRATED BEHAVIORAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E CHARLESTON BLVD
LAS VEGAS NV
89104-1902
US

IV. Provider business mailing address

1721 E CHARLESTON BLVD
LAS VEGAS NV
89104-1902
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-9680
  • Fax:
Mailing address:
  • Phone: 702-515-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberNV20131553514
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNV20131553514
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberNV20131553514
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberNV20131553514
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberNV20131553514
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNV20131553514
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberNV20131553514
License Number StateNV
# 8
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNV20131553514
License Number StateNV

VIII. Authorized Official

Name: FESTUS EBONKA
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 702-515-9680