Healthcare Provider Details

I. General information

NPI: 1225546351
Provider Name (Legal Business Name): TRUE HEARTS CARE QUALITY BEHAVIORAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 W HARMON AVE UNIT 2193
LAS VEGAS NV
89103-7049
US

IV. Provider business mailing address

5415 W HARMON AVE UNIT 2193
LAS VEGAS NV
89103-7049
US

V. Phone/Fax

Practice location:
  • Phone: 702-801-9180
  • Fax:
Mailing address:
  • Phone: 702-801-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HAMPTON
Title or Position: CEO
Credential:
Phone: 702-801-9181