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General NPI Number Information
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NPI Number | 1609692169
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Entity Type | Organization
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Legal Business Name | SUMMERLIN SERENITY P.L.L.C.
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 8044 REDBUD VINE ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89085-4455
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Country | US
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Telephone | 702-556-9891
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Fax |
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Provider Business Mailing Address
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Address Line | 8044 REDBUD VINE ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89085-4455
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Country | US
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Telephone | 702-556-9891
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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 | MR. ALLEN SHAMON
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Credential | LICSW, LCSW
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Telephone | 209-568-5346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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