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General NPI Number Information
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NPI Number | 1174865331
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Entity Type | Organization
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Legal Business Name | MARQUEZ FAMILY SERVICES
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 7224 DIAMOND HOPE CT
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City | LAS VEGAS
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State | NV
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Zip | 89129-4403
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Country | US
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Telephone | 702-472-3137
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Fax |
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Provider Business Mailing Address
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Address Line | 3652 N RANCHO DR SUITE # 102
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City | LAS VEGAS
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State | NV
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Zip | 89130-3178
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Country | US
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Telephone | 702-472-3137
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Fax |
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Authorized Official
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Title or Position | DIRECT SUPERVISOR
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Name | BEATRICE MARQUEZ
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Credential | MA, MFT-INTERN
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Telephone | 702-472-3137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | P50-03087-2-164460
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License Number State | NV
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