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General NPI Number Information
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NPI Number | 1780813451
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Entity Type | Organization
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Legal Business Name | HEADSUP GUIDANCE AND WELLNESS CENTERS OF NEVADA
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 340 N 11TH ST SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89101-3125
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Country | US
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Telephone | 702-922-7015
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Fax | 702-922-6600
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Provider Business Mailing Address
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Address Line | 340 N 11TH ST SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89101-3125
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Country | US
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Telephone | 702-922-7015
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Fax | 702-922-6600
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | MRS. JUDY ANN WHITE
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Credential | BSW
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Telephone | 702-845-2939
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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 | 1007683490
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License Number State | NV
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