Healthcare Provider Details

I. General information

NPI: 1194587576
Provider Name (Legal Business Name): EVER BRAVE TREATMENT CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8689 W SAHARA AVE STE 100
LAS VEGAS NV
89117-5871
US

IV. Provider business mailing address

370 E 1375 S
KAYSVILLE UT
84037-3074
US

V. Phone/Fax

Practice location:
  • Phone: 702-330-5665
  • Fax:
Mailing address:
  • Phone: 801-414-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYNNE SILL
Title or Position: CEO
Credential: LCSW
Phone: 801-414-4250