Healthcare Provider Details

I. General information

NPI: 1184195430
Provider Name (Legal Business Name): MULTICULTURAL COUNSELING COLLABORATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 S JONES BLVD STE 225
LAS VEGAS NV
89146-5622
US

IV. Provider business mailing address

2920 S JONES BLVD STE 225
LAS VEGAS NV
89146-5622
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-6395
  • Fax: 702-485-1278
Mailing address:
  • Phone: 702-476-6395
  • Fax: 702-485-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORIE ALSTON
Title or Position: CONTRACT MANAGER
Credential:
Phone: 702-476-6395