Healthcare Provider Details

I. General information

NPI: 1295073724
Provider Name (Legal Business Name): RED ROCK PSYCHOLOGICAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E TROPICANA AVE STE 580
LAS VEGAS NV
89119-6517
US

IV. Provider business mailing address

1515 E TROPICANA AVE STE 580
LAS VEGAS NV
89119-6517
US

V. Phone/Fax

Practice location:
  • Phone: 702-898-5311
  • Fax: 702-222-3275
Mailing address:
  • Phone: 702-898-5311
  • Fax: 702-222-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5480-C
License Number StateNV

VIII. Authorized Official

Name: MELISSA WEBB
Title or Position: MANAGER
Credential: LCSW
Phone: 702-898-5311