Healthcare Provider Details

I. General information

NPI: 1043647977
Provider Name (Legal Business Name): JOSHUA K LARGUSA-STEPHENS B.S. OF PSYCHOLGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 EAST PATRICK LANE SUITE 101
LAS VEGAS NV
89120-4902
US

IV. Provider business mailing address

3420 BEDFORDSHIRE PL
LAS VEGAS NV
89129-7370
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-6264
  • Fax: 702-998-6270
Mailing address:
  • Phone: 702-499-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1604718566
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: