Healthcare Provider Details

I. General information

NPI: 1538527874
Provider Name (Legal Business Name): MEADOWS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9402 W LAKE MEAD BLVD
LAS VEGAS NV
89134-8312
US

IV. Provider business mailing address

9402 W LAKE MEAD BLVD
LAS VEGAS NV
89134-8312
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-0554
  • Fax: 702-438-7830
Mailing address:
  • Phone: 702-878-0554
  • Fax: 702-438-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0396
License Number StateNV

VIII. Authorized Official

Name: ROBERTA VANDE VOORT
Title or Position: CEO
Credential: MS, MFT
Phone: 702-878-0554