Healthcare Provider Details

I. General information

NPI: 1568742070
Provider Name (Legal Business Name): PSYCHIATRIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S JONES BLVD
LAS VEGAS NV
89146-5306
US

IV. Provider business mailing address

PO BOX 91075
HENDERSON NV
89009-1075
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-0674
  • Fax: 702-566-4575
Mailing address:
  • Phone: 702-685-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNV12623
License Number StateNV

VIII. Authorized Official

Name: DR. GARGI TRIVEDI
Title or Position: OWNER
Credential: MD
Phone: 702-685-0674