Healthcare Provider Details

I. General information

NPI: 1417766551
Provider Name (Legal Business Name): CARE & CRISIS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 N RANCHO DR STE 106
LAS VEGAS NV
89130-3151
US

IV. Provider business mailing address

3650 N RANCHO DR STE 106
LAS VEGAS NV
89130-3151
US

V. Phone/Fax

Practice location:
  • Phone: 702-740-4532
  • Fax: 702-760-4585
Mailing address:
  • Phone: 702-740-4532
  • Fax: 702-760-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAQUES WILLIAMS
Title or Position: DIRECTOR
Credential:
Phone: 702-740-4532