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General NPI Number Information
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NPI Number | 1609212182
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Entity Type | Organization
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Legal Business Name | ETERNITY'S PATH
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Dates
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Enumeration Date | 05/10/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 1345 N HOLLYWOOD BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89110-2021
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Country | US
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Telephone | 702-758-5961
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Fax |
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Provider Business Mailing Address
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Address Line | 5546 CAMINO AL NORTE # 2-333
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-0805
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Country | US
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Telephone | 702-540-8296
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SARITA EDWARDS
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Credential |
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Telephone | 702-540-8296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | NV20131272872
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | NV20131272872
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | NV20131272872
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | NV20131272872
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV20131272872
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License Number State | NV
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