Healthcare Provider Details

I. General information

NPI: 1437017720
Provider Name (Legal Business Name): SECOND CHANCE COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 S 6TH ST STE R
LAS VEGAS NV
89101-6948
US

IV. Provider business mailing address

6396 MCLEOD DR STE 10
LAS VEGAS NV
89120-4429
US

V. Phone/Fax

Practice location:
  • Phone: 702-482-8582
  • Fax:
Mailing address:
  • Phone: 702-518-6444
  • Fax: 702-374-0233

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CARLOS R CISNEROS
Title or Position: LCSW
Credential: LCSW
Phone: 702-482-8580