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General NPI Number Information
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NPI Number | 1346657319
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Entity Type | Organization
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Legal Business Name | BAILOUS BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 1422 CROSSDALE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89142-0180
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Country | US
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Telephone | 702-330-1175
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 CROSSDALE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89142-0180
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Country | US
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Telephone | 702-330-1175
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GAIL MARIE BAILOUS
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Credential | ETC
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Telephone | 702-330-1175
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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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