Healthcare Provider Details

I. General information

NPI: 1639733579
Provider Name (Legal Business Name): CLARK COUNTY BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 S EASTERN AVE
LAS VEGAS NV
89119-7825
US

IV. Provider business mailing address

2375 E TROPICANA AVE STE 144
LAS VEGAS NV
89119-6564
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-0599
  • Fax:
Mailing address:
  • Phone: 702-244-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEILAN L DAGUMAN
Title or Position: NP
Credential: NP
Phone: 702-815-6350