Healthcare Provider Details

I. General information

NPI: 1184942815
Provider Name (Legal Business Name): A LIST FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 E PATRICK LN STE 101
LAS VEGAS NV
89120-4902
US

IV. Provider business mailing address

3960 E PATRICK LN STE 101
LAS VEGAS NV
89120-4902
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-6264
  • Fax: 702-998-6270
Mailing address:
  • Phone: 702-998-6264
  • Fax: 702-998-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNV5802
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCP0090
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN001471
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNV10794
License Number StateNV

VIII. Authorized Official

Name: MR. UALAPA MIKA FONOTISATELE JR.
Title or Position: PRESIDENT/OWNER
Credential: QMHA-ASSOCIATES
Phone: 702-321-9273