Healthcare Provider Details

I. General information

NPI: 1013330695
Provider Name (Legal Business Name): PRO-HEALTH THERAPEUTIC & EMPOWERMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2014
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 E DESERT INN RD STE 260
LAS VEGAS NV
89121-3690
US

IV. Provider business mailing address

2620 S MARYLAND PKWY # 14-199
LAS VEGAS NV
89109-8300
US

V. Phone/Fax

Practice location:
  • Phone: 702-490-9009
  • Fax: 866-737-6147
Mailing address:
  • Phone: 702-490-9009
  • Fax: 866-737-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEISHA GRAHAM
Title or Position: OPERATIONS
Credential:
Phone: 702-490-9009