Healthcare Provider Details

I. General information

NPI: 1639998263
Provider Name (Legal Business Name): CRISIS CARE AND LIFE ENHANCEMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N RAINBOW BLVD STE 120
LAS VEGAS NV
89107-1190
US

IV. Provider business mailing address

800 N RAINBOW BLVD STE 120
LAS VEGAS NV
89107-1190
US

V. Phone/Fax

Practice location:
  • Phone: 702-966-7340
  • Fax:
Mailing address:
  • Phone: 702-966-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANTWONE OWENS SR.
Title or Position: OWNER
Credential:
Phone: 725-293-1333