=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154201077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAY AND LESBIAN COMMUNITY CENTER OF SOUTHERN NEVADA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2025
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 S MARYLAND PKWY
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89101-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-802-5410
-----------------------------------------------------
Fax | 702-476-9717
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 S MARYLAND PKWY
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89101-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-802-5410
-----------------------------------------------------
Fax | 702-476-9717
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MS
-----------------------------------------------------
Name | MONA LISA PAULO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-802-5410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------