Healthcare Provider Details

I. General information

NPI: 1487121190
Provider Name (Legal Business Name): NEVADA NEUROFEEDBACK AND HYPNOSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S MARYLAND PKWY STE 5
LAS VEGAS NV
89104-3225
US

IV. Provider business mailing address

6895 E. LAKE MEAD BLVD SUITE 6 #200
LAS VEGAS NV
89156-6767
US

V. Phone/Fax

Practice location:
  • Phone: 702-329-4262
  • Fax: 702-825-0015
Mailing address:
  • Phone: 702-329-4262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LOUIS M HAYNIE
Title or Position: MANAGING PARTNER
Credential: LCSW
Phone: 702-329-4262