Healthcare Provider Details

I. General information

NPI: 1194420885
Provider Name (Legal Business Name): AGDFVCOUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10161 PARK RUN DR STE 150
LAS VEGAS NV
89145-8872
US

IV. Provider business mailing address

6130 W FLAMINGO RD # 635
LAS VEGAS NV
89103-2280
US

V. Phone/Fax

Practice location:
  • Phone: 702-250-6867
  • Fax: 702-793-2901
Mailing address:
  • Phone: 702-250-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. FARBOD VALINIA
Title or Position: OWNER
Credential: LCPC
Phone: 702-250-6867