=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336716901
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN TOUCH BEHAVIORAL CARE CENTER PROF CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2021
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2225 E FLAMINGO RD STE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-5126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-493-8733
-----------------------------------------------------
Fax | 702-903-4499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2225 E FLAMINGO RD STE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-5126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-493-8733
-----------------------------------------------------
Fax | 702-903-4499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DELMA STAFFORD
-----------------------------------------------------
Credential | MSW, CADC-I
-----------------------------------------------------
Telephone | 725-286-9202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------