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General NPI Number Information
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NPI Number | 1114506003
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Entity Type | Organization
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Legal Business Name | BISON HEALTH LLC
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 11201 N TATUM BLVD STE 360-42
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City | PHOENIX
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State | AZ
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Zip | 85028-6036
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Country | US
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Telephone | 725-222-9502
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Fax | 725-209-0381
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Provider Business Mailing Address
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Address Line | 4132 S RAINBOW BLVD # 149
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City | LAS VEGAS
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State | NV
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Zip | 89103-3106
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Country | US
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Telephone | 725-222-9502
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Fax | 725-209-0381
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MELANIE BISON
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Credential | PHD
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Telephone | 725-222-9502
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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 | 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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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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