Healthcare Provider Details

I. General information

NPI: 1417719022
Provider Name (Legal Business Name): ASD.ME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10845 GRIFFITH PEAK DR STE 200
LAS VEGAS NV
89135-1568
US

IV. Provider business mailing address

10245 JERSEY SHORE AVE
LAS VEGAS NV
89135-1153
US

V. Phone/Fax

Practice location:
  • Phone: 646-645-2108
  • Fax: 702-904-9746
Mailing address:
  • Phone: 646-645-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL E JOHNSON
Title or Position: CEO
Credential:
Phone: 888-279-9898