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General NPI Number Information
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NPI Number | 1790300010
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Entity Type | Organization
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Legal Business Name | ESPOIR BEHAVIOR HEALTH LLC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 1298 HIGHGATE CT
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City | SPARKS
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State | NV
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Zip | 89434-0762
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Country | US
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Telephone | 775-771-0158
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Fax |
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Provider Business Mailing Address
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Address Line | 1298 HIGHGATE CT
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City | SPARKS
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State | NV
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Zip | 89434-0762
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Country | US
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Telephone | 775-771-0158
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MISS GERVINE NADINE NGOMA MOUTOMBO
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Credential |
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Telephone | 775-771-0158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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