Healthcare Provider Details

I. General information

NPI: 1073103867
Provider Name (Legal Business Name): BROTHERS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N RAINBOW BLVD STE 170160
LAS VEGAS NV
89107-1189
US

IV. Provider business mailing address

800 N RAINBOW BLVD STE 170160
LAS VEGAS NV
89107-1189
US

V. Phone/Fax

Practice location:
  • Phone: 702-412-4763
  • Fax:
Mailing address:
  • Phone: 702-412-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ISAI ANAYA-ESTRADA
Title or Position: MANAGING MEMBER
Credential:
Phone: 702-412-4763