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General NPI Number Information
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NPI Number | 1265094775
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Entity Type | Organization
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Legal Business Name | EQUITY BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 07/04/2019
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 2001 S JONES BLVD STE J
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City | LAS VEGAS
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State | NV
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Zip | 89146-3165
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Country | US
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Telephone | 702-712-0291
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Fax |
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Provider Business Mailing Address
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Address Line | 7099 N HUALAPAI WAY APT 1116
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City | LAS VEGAS
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State | NV
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Zip | 89166-1107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TYRON MALLARD
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Credential | MSW, LCPC
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Telephone | 323-359-7804
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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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