Healthcare Provider Details

I. General information

NPI: 1548494644
Provider Name (Legal Business Name): BUILDING INTELLIGENT GENERATIONS III INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 PARADISE RD # 15-297
LAS VEGAS NV
89169-4834
US

IV. Provider business mailing address

4080 PARADISE RD # 15-297
LAS VEGAS NV
89169-4834
US

V. Phone/Fax

Practice location:
  • Phone: 702-883-9591
  • Fax:
Mailing address:
  • Phone: 702-883-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNV

VIII. Authorized Official

Name: MR. TIMOTHY JOHNSON
Title or Position: PRESIDENT /DIRECTOR
Credential:
Phone: 702-883-9591