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General NPI Number Information
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NPI Number | 1487320198
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Entity Type | Organization
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Legal Business Name | THERE & BACK RECOVERY SERVICES, LLC
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Dates
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Enumeration Date | 08/22/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 734 E SAHARA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89104-2913
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Country | US
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Telephone | 765-537-8480
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Fax |
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Provider Business Mailing Address
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Address Line | 1810 E SAHARA AVE STE 439
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City | LAS VEGAS
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State | NV
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Zip | 89104-3707
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Country | US
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Telephone |
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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 | MALIEKA D TOSTON
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Credential | LADC
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Telephone | 702-714-1739
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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 |
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License Number State |
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Taxonomy #2
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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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