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General NPI Number Information
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NPI Number | 1114547726
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Entity Type | Organization
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Legal Business Name | LIFESPAN BEHAVIORAL HEALTH NEVADA PC
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 2401 W HORIZON RIDGE PKWY STE 110
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City | HENDERSON
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State | NV
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Zip | 89052-2707
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Country | US
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Telephone | 702-544-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 2505 ANTHEM VILLAGE DR STE E-508
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City | HENDERSON
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State | NV
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Zip | 89052-5505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE ADMIN
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Name | CAROLYN REIDY
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Credential |
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Telephone | 800-819-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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