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General NPI Number Information
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NPI Number | 1114307238
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Entity Type | Organization
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Legal Business Name | T & Z PSYCHOTHERAPY PRACTICE, LLC
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 5135 CAMINO AL NORTE SUITE 279
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-2387
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Country | US
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Telephone | 702-853-6708
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Fax | 702-853-6709
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Provider Business Mailing Address
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Address Line | 5135 CAMINO AL NORTE SUITE 279
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-2387
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Country | US
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Telephone | 702-853-6708
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Fax | 702-853-6709
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Authorized Official
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Title or Position | OWNER
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Name | CINDY JACKSON
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Credential | LCSW
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Telephone | 702-853-6708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5580-C
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License Number State | NV
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