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General NPI Number Information
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NPI Number | 1023590544
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Entity Type | Organization
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Legal Business Name | STONEBRIDGE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 3311 S RAINBOW BLVD STE 112
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City | LAS VEGAS
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State | NV
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Zip | 89146-6596
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Country | US
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Telephone | 702-772-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 3311 S RAINBOW BLVD STE 112
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City | LAS VEGAS
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State | NV
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Zip | 89146-6596
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Country | US
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Telephone | 702-772-4446
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELISSA J REECE-THOMPSON
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Credential |
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Telephone | 702-772-4446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV20171534971
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License Number State | NV
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