Healthcare Provider Details

I. General information

NPI: 1619865201
Provider Name (Legal Business Name): TRYDENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N EASTERN AVE STE 102
LAS VEGAS NV
89101-4544
US

IV. Provider business mailing address

6935 ALIANTE PKWY STE 104-421
NORTH LAS VEGAS NV
89084-5818
US

V. Phone/Fax

Practice location:
  • Phone: 702-333-1054
  • 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: MARTIN BROTHERS
Title or Position: DIRECTOR
Credential:
Phone: 702-333-1054