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General NPI Number Information
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NPI Number | 1326354309
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Entity Type | Organization
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Legal Business Name | SERENITY COUNSELING AND SUPPORT SERVICES
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 578 REDRUTH DR
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City | LAS VEGAS
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State | NV
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Zip | 89178-1282
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Country | US
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Telephone | 702-376-0024
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Fax | 702-479-7173
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Provider Business Mailing Address
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Address Line | PO BOX 60561
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City | BOULDER CITY
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State | NV
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Zip | 89006-0561
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Country | US
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Telephone | 702-376-0024
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Fax | 702-479-7173
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. SOMMER THYME BERGDALE
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Credential | M.A.
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Telephone | 702-376-0024
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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 | 5554-C
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License Number State | NV
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