Healthcare Provider Details

I. General information

NPI: 1811310584
Provider Name (Legal Business Name): EXODUS FAMILY & GUIDANCE COALITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S MARYLAND PKWY
LAS VEGAS NV
89104-3311
US

IV. Provider business mailing address

9110 W LONE MOUNTAIN RD
LAS VEGAS NV
89129-3563
US

V. Phone/Fax

Practice location:
  • Phone: 702-466-4360
  • Fax:
Mailing address:
  • Phone: 702-466-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN DELCINA LEE
Title or Position: OWNER
Credential: ED.D.
Phone: 702-466-4360