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General NPI Number Information
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NPI Number | 1194340471
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Entity Type | Organization
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Legal Business Name | TRAC-B EXCHANGE LLC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 6114 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89146-1127
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Country | US
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Telephone | 702-840-6693
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Fax |
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Provider Business Mailing Address
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Address Line | 6540 BRADLEY RD
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City | LAS VEGAS
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State | NV
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Zip | 89131-2913
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Country | US
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Telephone | 702-840-6693
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MS. CHELSI CHEATOM
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Credential |
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Telephone | 702-840-6693
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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 |
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License Number State |
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Taxonomy #2
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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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