=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376774877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIDDENS & ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2009
-----------------------------------------------------
Last Update Date | 07/31/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 MARION DR
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89110-4666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-445-6594
-----------------------------------------------------
Fax | 702-982-8712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 MARION DR
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89110-4666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-445-6594
-----------------------------------------------------
Fax | 702-982-8712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. RAYMOND LOUIS GIDDENS JR.
-----------------------------------------------------
Credential | MSW, LSW
-----------------------------------------------------
Telephone | 702-501-6725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 5095-C
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------