Healthcare Provider Details

I. General information

NPI: 1003439175
Provider Name (Legal Business Name): RED ROCK COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2020
Last Update Date: 05/24/2020
Certification Date: 05/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10655 PARK RUN DR STE 210
LAS VEGAS NV
89144-4590
US

IV. Provider business mailing address

10655 PARK RUN DR STE 210
LAS VEGAS NV
89144-4590
US

V. Phone/Fax

Practice location:
  • Phone: 702-389-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN DOW
Title or Position: PARTNER
Credential:
Phone: 702-389-4500