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General NPI Number Information
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NPI Number | 1093147159
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Entity Type | Organization
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Legal Business Name | INFINATE RA, LLC
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 2441 TECH CENTER CT SUITE 107
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City | LAS VEGAS
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State | NV
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Zip | 89128-0804
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Country | US
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Telephone | 702-938-8887
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Fax | 702-256-1805
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Provider Business Mailing Address
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Address Line | 2441 TECH CENTER CT SUITE 107
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City | LAS VEGAS
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State | NV
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Zip | 89128-0804
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Country | US
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Telephone | 702-938-8887
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Fax | 702-256-1805
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Authorized Official
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Title or Position | MAIN OFFICER
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Name | MS. CATHY A SMITH
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Credential | M.COUN
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Telephone | 702-938-8887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | NV
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