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General NPI Number Information
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NPI Number | 1730328790
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL PROBLEM GAMBLING CENTER
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Dates
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Enumeration Date | 02/16/2009
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Last Update Date | 02/16/2009
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Provider Practice Location Address
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Address Line | 2330 PASEO DEL PRADO STE C109
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City | LAS VEGAS
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State | NV
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Zip | 89102-4336
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Country | US
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Telephone | 702-363-3633
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Fax | 702-363-5244
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Provider Business Mailing Address
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Address Line | 2330 PASEO DEL PRADO STE C109
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City | LAS VEGAS
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State | NV
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Zip | 89102-4336
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Country | US
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Telephone | 702-363-3633
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Fax | 702-363-5244
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KRISTA LORRAINE CREELMAN
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Credential |
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Telephone | 702-363-3633
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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 |
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License Number State |
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