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General NPI Number Information
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NPI Number | 1053688283
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Entity Type | Organization
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Legal Business Name | HENDERSON SUBSTANCE ABUSE TREATMENT CENTER
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 2 IDAHO WAY
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City | HENDERSON
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State | NV
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Zip | 89015-7209
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Country | US
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Telephone | 702-565-6060
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Fax | 702-565-6097
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Provider Business Mailing Address
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Address Line | 2 IDAHO WAY
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City | HENDERSON
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State | NV
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Zip | 89015-7209
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Country | US
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Telephone | 702-565-6060
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Fax | 702-565-6097
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | LYNETTE STEWART
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Credential | CADC
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Telephone | 702-565-6060
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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 | 00309-C
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License Number State | NV
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