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General NPI Number Information
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NPI Number | 1013548817
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Entity Type | Organization
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Legal Business Name | ABRAXAS CENTER LLC
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 4575 W COUGAR AVE STE 300
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City | LAS VEGAS
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State | NV
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Zip | 89139-7617
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Country | US
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Telephone | 702-412-8405
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Fax |
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Provider Business Mailing Address
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Address Line | 4262 BLUE DIAMOND RD # 102-105
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City | LAS VEGAS
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State | NV
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Zip | 89139-7789
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Country | US
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Telephone | 702-412-8405
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | JENNY CASINO
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Credential | LCSW
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Telephone | 702-412-8405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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