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General NPI Number Information
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NPI Number | 1255767034
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Entity Type | Organization
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Legal Business Name | DIAMOND MENTAL HEALTH
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 3622 N RANCHO DR STE 102
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City | LAS VEGAS
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State | NV
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Zip | 89130-3161
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Country | US
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Telephone | 702-395-4002
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Fax | 702-395-4003
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Provider Business Mailing Address
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Address Line | 3622 N RANCHO DR STE 102
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City | LAS VEGAS
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State | NV
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Zip | 89130-3161
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Country | US
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Telephone | 702-395-4002
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Fax | 702-395-4003
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Authorized Official
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Title or Position | CEO
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Name | CONSTANCE KNIGHT
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Credential |
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Telephone | 702-395-4002
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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 | #1039
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License Number State | NV
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