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General NPI Number Information
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NPI Number | 1174386197
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Entity Type | Organization
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Legal Business Name | EMBARK PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 8879 W FLAMINGO RD STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89147-8732
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Country | US
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Telephone | 626-863-7569
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Fax |
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Provider Business Mailing Address
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Address Line | 7181 N HUALAPAI WAY STE 130-722
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City | LAS VEGAS
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State | NV
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Zip | 89166-1115
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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 | MANAGING MEMBER/OWNER
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Name | ROANNE VELARDE
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Credential | PSYD
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Telephone | 626-863-7569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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