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General NPI Number Information
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NPI Number | 1063075513
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Entity Type | Organization
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Legal Business Name | COUNSELING AND NEURO DYNAMICS LLC
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 6655 W SAHARA AVE # 106
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City | LAS VEGAS
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State | NV
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Zip | 89146-0842
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Country | US
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Telephone | 773-619-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 5940 S RAINBOW BLVD STE 1004
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City | LAS VEGAS
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State | NV
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Zip | 89118-2506
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Country | US
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Telephone | 773-619-2001
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DEVONE VERSE
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Credential | PH.D./CPC
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Telephone | 773-619-2001
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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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 | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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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 | 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 #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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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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