Healthcare Provider Details

I. General information

NPI: 1225887375
Provider Name (Legal Business Name): PSYCHIATRY SERVICES PROFESSIONAL CORPORATION KHURANA JEIDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON BLVD # 142
LAS VEGAS NV
89146-9001
US

IV. Provider business mailing address

3225 MCLEOD DR STE 100
LAS VEGAS NV
89121-2257
US

V. Phone/Fax

Practice location:
  • Phone: 702-440-8430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY JEIDER
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 702-440-8430