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General NPI Number Information
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NPI Number | 1083869663
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Entity Type | Organization
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Legal Business Name | RED ROCK GUIDANCE & WELLNESS CENTER
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 2580 MONTESSOURI STREET
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City | LAS VEGAS
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State | NV
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Zip | 89117-3065
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Country | US
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Telephone | 702-947-4749
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Fax | 702-256-2295
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Provider Business Mailing Address
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Address Line | 2580 MONTESSOURI STREET
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City | LAS VEGAS
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State | NV
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Zip | 89117-3065
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Country | US
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Telephone | 702-947-4749
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Fax | 702-256-2295
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Authorized Official
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Title or Position | CEO
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Name | DR. YOLANDA TREVINO
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Credential | PH.D.
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Telephone | 702-947-4749
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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 | 0936
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License Number State | NV
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