Healthcare Provider Details

I. General information

NPI: 1851782999
Provider Name (Legal Business Name): NEVADA INTEGRATED BEHAVIORAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E CHARLESTON BLVD
LAS VEGAS NV
89104-1902
US

IV. Provider business mailing address

1721 E CHARLESTON BLVD
LAS VEGAS NV
89104-1902
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-9680
  • Fax:
Mailing address:
  • Phone: 702-515-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberNV20131553514
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberNV20131553514
License Number StateNV

VIII. Authorized Official

Name: MR. FESTUS EBONKA
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 702-515-9680