Healthcare Provider Details

I. General information

NPI: 1932926763
Provider Name (Legal Business Name): MARSHALL MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 E FLAMINGO RD STE A
LAS VEGAS NV
89121-5201
US

IV. Provider business mailing address

6161 SHELTER CREEK AVE
LAS VEGAS NV
89110-3925
US

V. Phone/Fax

Practice location:
  • Phone: 702-217-5639
  • Fax: 702-514-6249
Mailing address:
  • Phone: 702-217-5639
  • Fax: 702-514-6249

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 Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JODY L. MARSHALL
Title or Position: DIRECTOR
Credential: MS, LCPC, LCADC-S
Phone: 702-217-5639