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General NPI Number Information
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NPI Number | 1356766497
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Entity Type | Organization
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Legal Business Name | LV PSYCHIATRIC CARE
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 8872 S EASTERN AVE STE. 250
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City | LAS VEGAS
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State | NV
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Zip | 89123
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Country | US
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Telephone | 702-492-9439
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Fax | 702-492-9537
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Provider Business Mailing Address
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Address Line | 2654 W HORIZON RIDGE PKWY STE. B5-287
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City | HENDERSON
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State | NV
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Zip | 89052
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Country | US
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Telephone | 702-492-9439
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Fax | 702-492-9537
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Authorized Official
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Title or Position | ATTENDING PHYSICIAN
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Name | DIANA LOWRY HAVILL
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Credential | MD
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Telephone | 702-492-9439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 13759
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License Number State | NV
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