Healthcare Provider Details

I. General information

NPI: 1356733174
Provider Name (Legal Business Name): TRIUMPHANT FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 MCLEOD DR STE 6-8
LAS VEGAS NV
89120-4428
US

IV. Provider business mailing address

6396 MCLEOD DR STE 6-8
LAS VEGAS NV
89120-4428
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PATRICK RUSSEL
Title or Position: DIRECT SUPERVISOR
Credential:
Phone: 702-912-0600