Healthcare Provider Details

I. General information

NPI: 1154075570
Provider Name (Legal Business Name): LAZOS BEHAVIORAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N EASTERN AVE STE 120
LAS VEGAS NV
89101-2885
US

IV. Provider business mailing address

4913 SPARKLING SKY AVE
LAS VEGAS NV
89130-7256
US

V. Phone/Fax

Practice location:
  • Phone: 170-258-0185
  • Fax:
Mailing address:
  • Phone: 170-258-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARIA FERNANDA MITCHELL
Title or Position: DIRECTOR
Credential:
Phone: 702-580-1850