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General NPI Number Information
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NPI Number | 1679087027
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Entity Type | Organization
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Legal Business Name | DIVINE INSTRUCTIONS BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 511 N LAMB BLVD APT 3
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City | LAS VEGAS
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State | NV
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Zip | 89110
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Country | US
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Telephone | 702-587-2309
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Fax |
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Provider Business Mailing Address
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Address Line | 511 N LAMB BLVD APT 3
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City | LAS VEGAS
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State | NV
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Zip | 89110-3362
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Country | US
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Telephone | 702-587-2309
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNIFERANN FRAZIER
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Credential |
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Telephone | 702-587-2309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV20171725686
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License Number State | NV
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