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General NPI Number Information
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NPI Number | 1447736012
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Entity Type | Organization
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Legal Business Name | STEPPING OUT ON FAITH BH
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 5901 N GRAND CANYON DR
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City | LAS VEGAS
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State | NV
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Zip | 89149-1405
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Country | US
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Telephone | 702-542-0407
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Fax |
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Provider Business Mailing Address
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Address Line | 4710 LUXOR WAY APT 2219
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City | LAS VEGAS
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State | NV
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Zip | 89115-3023
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Country | US
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Telephone | 702-278-0340
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MARY A BEY-ANDERSON
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Credential |
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Telephone | 702-278-0340
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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 | 82-3082387
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License Number State | NV
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