Healthcare Provider Details

I. General information

NPI: 1467785527
Provider Name (Legal Business Name): DESERT BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 SPENCER ST STE 118
LAS VEGAS NV
89119-5250
US

IV. Provider business mailing address

4055 SPENCER ST STE 118
LAS VEGAS NV
89119-5250
US

V. Phone/Fax

Practice location:
  • Phone: 702-799-9710
  • Fax: 702-799-9712
Mailing address:
  • Phone: 702-799-9710
  • Fax: 702-799-9712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1008584355-000
License Number StateNV

VIII. Authorized Official

Name: QINGFANG ZHANG
Title or Position: CEO/CLINICAL DIRECTOR
Credential: PHD, LCSW
Phone: 702-799-9710