Healthcare Provider Details

I. General information

NPI: 1023454428
Provider Name (Legal Business Name): FAMILY AND CHILD TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 W SAHARA AVE SUITE 200
LAS VEGAS NV
89146-3069
US

IV. Provider business mailing address

6431 W SAHARA AVE SUITE 200
LAS VEGAS NV
89146-3069
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-5855
  • Fax: 702-258-9767
Mailing address:
  • Phone: 702-258-5855
  • Fax: 702-258-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberNV19841011323
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNV19841011323
License Number StateNV

VIII. Authorized Official

Name: MS. HEATHER GIBBS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-258-5855