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General NPI Number Information
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NPI Number | 1225847601
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Entity Type | Organization
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Legal Business Name | PRO-HEALTH THERAPEUTIC & EMPOWERMENT SERVICES LLC
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 2755 E DESERT INN RD STE 260
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City | LAS VEGAS
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State | NV
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Zip | 89121-3690
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Country | US
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Telephone | 702-490-9009
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Fax | 866-737-6147
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Provider Business Mailing Address
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Address Line | 2620 S MARYLAND PKWY STE 14-199
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City | LAS VEGAS
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State | NV
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Zip | 89109-8300
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Country | US
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Telephone | 702-490-9009
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Fax | 866-737-6147
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Authorized Official
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Title or Position | OPERATIONS
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Name | KEISHA GRAHAM
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Credential |
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Telephone | 702-490-9009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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