Healthcare Provider Details

I. General information

NPI: 1205407178
Provider Name (Legal Business Name): ADVANTAGE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 S RAINBOW BLVD STE C102
LAS VEGAS NV
89146-5181
US

IV. Provider business mailing address

2625 S RAINBOW BLVD STE C102
LAS VEGAS NV
89146-5181
US

V. Phone/Fax

Practice location:
  • Phone: 702-403-7999
  • Fax:
Mailing address:
  • Phone: 702-403-7999
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL AMATO VON HEMERT
Title or Position: MANAGING MENBER
Credential:
Phone: 702-835-2396