Healthcare Provider Details

I. General information

NPI: 1780217679
Provider Name (Legal Business Name): 58 10 BEHAVIORAL HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 E SAHARA AVE STE 212 373
LAS VEGAS NV
89104-3707
US

IV. Provider business mailing address

1810 E SAHARA AVE STE 212 373
LAS VEGAS NV
89104-3707
US

V. Phone/Fax

Practice location:
  • Phone: 702-286-5386
  • Fax: 702-566-4575
Mailing address:
  • Phone: 702-286-5386
  • Fax: 702-566-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALVIN KENON
Title or Position: OWNER
Credential: LCSW
Phone: 702-286-5386