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General NPI Number Information
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NPI Number | 1295288553
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Entity Type | Organization
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Legal Business Name | BOARD OF REGENTS NEVADA SYSTEM OF HIGHER EDUCATION
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 630 S. RANCHO, STE. A
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City | LAS VEGAS
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State | NV
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Zip | 89106
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Country | US
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Telephone | 702-998-9505
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Fax |
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Provider Business Mailing Address
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Address Line | 630 S. RANCHO, STE. A
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City | LAS VEGAS
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State | NV
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Zip | 89106
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Country | US
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Telephone | 702-998-9505
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Fax |
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Authorized Official
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Title or Position | VICE DEAN OF CLINICAL AFFAIRS
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Name | TRACEY GREEN
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Credential | M.D.
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Telephone | 702-998-9505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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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 | 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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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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