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General NPI Number Information
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NPI Number | 1437385408
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Entity Type | Organization
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Legal Business Name | CIRCLE OF CHANGE ADOLESCENT BEHAVIORAL HEALTH COUNSELING CENTER
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 06/04/2009
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Provider Practice Location Address
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Address Line | 5516 S FORT APACHE RD STE 120
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City | LAS VEGAS
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State | NV
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Zip | 89148-7679
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Country | US
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Telephone | 702-479-1629
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Fax |
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Provider Business Mailing Address
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Address Line | 5516 S FORT APACHE RD STE 120
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City | LAS VEGAS
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State | NV
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Zip | 89148-7679
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Country | US
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Telephone | 702-479-1629
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. SYLVIA NASEATH
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Credential | PHD, LCSW, LADC
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Telephone | 702-479-1629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 01201-L
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 01010
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4785-C
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License Number State | NV
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