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General NPI Number Information
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NPI Number | 1245772813
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Entity Type | Organization
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Legal Business Name | HEBRON BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 1600 E DESERT INN RD SUITE 104
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City | LAS VEGAS
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State | NV
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Zip | 89169-2525
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Country | US
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Telephone | 855-432-7662
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Fax | 888-812-4428
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Provider Business Mailing Address
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Address Line | 848 N RAINBOW BLVD UNIT 2063
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City | LAS VEGAS
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State | NV
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Zip | 89107-1103
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Country | US
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Telephone | 855-432-7662
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Fax | 888-812-4428
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Authorized Official
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Title or Position | CEO
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Name | ROSE M HOWARD
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Credential | LCPC, NCC, MAC IAADC
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Telephone | 855-432-7662
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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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