Healthcare Provider Details

I. General information

NPI: 1932585718
Provider Name (Legal Business Name): JOURNEYS ADOLESCENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 W LAKE MEAD BLVD # 9-481
LAS VEGAS NV
89128-0297
US

IV. Provider business mailing address

7500 W LAKE MEAD BLVD # 9-481
LAS VEGAS NV
89128-0297
US

V. Phone/Fax

Practice location:
  • Phone: 866-556-2926
  • Fax:
Mailing address:
  • Phone: 866-556-2926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: HORACE MILLER
Title or Position: PRESIDENT
Credential:
Phone: 866-556-2926