Healthcare Provider Details

I. General information

NPI: 1053853119
Provider Name (Legal Business Name): ALANDRIUS SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 W CHARLESTON BLVD STE 318
LAS VEGAS NV
89102-1859
US

IV. Provider business mailing address

2696 MATOGROSO LN
LAS VEGAS NV
89121-1539
US

V. Phone/Fax

Practice location:
  • Phone: 318-669-9383
  • Fax:
Mailing address:
  • Phone: 702-305-0652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: