Healthcare Provider Details

I. General information

NPI: 1487101549
Provider Name (Legal Business Name): TRILLITY CARE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 S. PECOS RD 203-1
LAS VEGAS NV
89121
US

IV. Provider business mailing address

4760 S. PECOS RD 203-1
LAS VEGAS NV
89121
US

V. Phone/Fax

Practice location:
  • Phone: 702-601-2697
  • Fax:
Mailing address:
  • Phone: 702-601-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number21061517540
License Number StateNV

VIII. Authorized Official

Name: BEVERLY NATAUSHA WILLIAMS
Title or Position: CHEIF EXECUTIVE OFFICER
Credential:
Phone: 702-601-2697