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General NPI Number Information
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NPI Number | 1770960874
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Entity Type | Organization
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Legal Business Name | SOUTHERN NEVADA BEHAVIORAL HEALTH AUTHORITY LLC
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6857 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89117-1600
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Country | US
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Telephone | 702-586-3050
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Fax | 702-586-3062
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Provider Business Mailing Address
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Address Line | 6883 W CHARLESTON BLVD STE A
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City | LAS VEGAS
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State | NV
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Zip | 89117-1645
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Country | US
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Telephone | 702-586-3050
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Fax | 702-586-3062
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MITRIECE AMELIA SUMBRY
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Credential | QMHA
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Telephone | 702-586-3050
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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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