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General NPI Number Information
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NPI Number | 1568579076
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Entity Type | Organization
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Legal Business Name | SOUTHER NEVADA ADULT MENTAL HEALTH
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 6161 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89146-1126
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Country | US
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Telephone | 702-486-6000
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Fax | 702-486-6248
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Provider Business Mailing Address
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Address Line | 6161 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89146-1126
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Country | US
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Telephone | 702-486-6000
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Fax | 702-486-6248
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. MARIAM MARVASTI
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Credential | MD
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Telephone | 702-278-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 9126
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License Number State | NV
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