Healthcare Provider Details

I. General information

NPI: 1598379117
Provider Name (Legal Business Name): WESTERN STATE BEHAVIORAL HEALTH AND PSYCHIATRIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/02/2025
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 PECOS MCLEOD STE B
LAS VEGAS NV
89121-4304
US

IV. Provider business mailing address

3910 PECOS MCLEOD B-100
LAS VEGAS NV
89121-4304
US

V. Phone/Fax

Practice location:
  • Phone: 702-629-7577
  • Fax: 702-629-7616
Mailing address:
  • Phone: 702-476-5110
  • Fax: 702-476-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FRANCES NEDD
Title or Position: OWNER
Credential:
Phone: 702-476-5110