Healthcare Provider Details

I. General information

NPI: 1215749163
Provider Name (Legal Business Name): STRONGBRIDGE INTEGRATED SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4442 AVERY PARK AVE
LAS VEGAS NV
89110-5488
US

IV. Provider business mailing address

4442 AVERY PARK AVE
LAS VEGAS NV
89110-5488
US

V. Phone/Fax

Practice location:
  • Phone: 702-541-4817
  • Fax:
Mailing address:
  • Phone: 702-541-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: OLUGBENGA OBAJUWONLO
Title or Position: MD
Credential:
Phone: 702-541-4817