Healthcare Provider Details

I. General information

NPI: 1780813451
Provider Name (Legal Business Name): HEADSUP GUIDANCE AND WELLNESS CENTERS OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 N 11TH ST SUITE 100
LAS VEGAS NV
89101-3125
US

IV. Provider business mailing address

340 N 11TH ST SUITE 100
LAS VEGAS NV
89101-3125
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax: 702-922-6600
Mailing address:
  • Phone: 702-922-7015
  • Fax: 702-922-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1007683490
License Number StateNV

VIII. Authorized Official

Name: MRS. JUDY ANN WHITE
Title or Position: DIRECTOR OF ADMINISTRATION
Credential: BSW
Phone: 702-845-2939