Healthcare Provider Details

I. General information

NPI: 1982096020
Provider Name (Legal Business Name): ZOOM MOBILE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 E. FLAMINGO STE E
LAS VEGAS NV
89121
US

IV. Provider business mailing address

5220 FOGGIA AVE
LAS VEGAS NV
89130-7059
US

V. Phone/Fax

Practice location:
  • Phone: 702-330-6693
  • Fax:
Mailing address:
  • Phone: 702-330-6693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberE0251852014-4
License Number StateNV

VIII. Authorized Official

Name: MR. ANDRE D WILLIAMS
Title or Position: OWNER
Credential: MA, CPC
Phone: 702-330-6693