Healthcare Provider Details

I. General information

NPI: 1972920163
Provider Name (Legal Business Name): AGAPE BH&FS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 N RANCHO DR STE 106
LAS VEGAS NV
89130-3150
US

IV. Provider business mailing address

3650 N RANCHO DR STE 106
LAS VEGAS NV
89130-3150
US

V. Phone/Fax

Practice location:
  • Phone: 702-740-5683
  • Fax: 702-740-5684
Mailing address:
  • Phone: 702-740-5683
  • Fax: 702-740-5684

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 Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS DELLISA GLORIES ARMSTRONG
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 702-606-8535