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General NPI Number Information
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NPI Number | 1649537333
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Entity Type | Organization
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Legal Business Name | LIONS CREST LLC
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 5420 W SAHARA AVE SUITE 102
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City | LAS VEGAS
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State | NV
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Zip | 89146-0394
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Country | US
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Telephone | 702-772-8892
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Fax |
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Provider Business Mailing Address
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Address Line | 5420 W SAHARA AVE SUITE 102
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City | LAS VEGAS
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State | NV
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Zip | 89146-0394
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Country | US
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Telephone | 702-772-8892
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. WASCAR CRUZ
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Credential |
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Telephone | 702-772-8892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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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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