Healthcare Provider Details

I. General information

NPI: 1396430682
Provider Name (Legal Business Name): PIVOT BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 E FLAMINGO RD STE 200A
LAS VEGAS NV
89119-0838
US

IV. Provider business mailing address

1771 E FLAMINGO RD STE 200A
LAS VEGAS NV
89119-0838
US

V. Phone/Fax

Practice location:
  • Phone: 702-527-2571
  • Fax:
Mailing address:
  • Phone: 702-527-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER LYNN WOODALL
Title or Position: OWNER
Credential: LCSW
Phone: 702-604-7767