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General NPI Number Information
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NPI Number | 1790405348
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Entity Type | Organization
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Legal Business Name | HEART LIGHT PSYCHIATRY LLC
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 2450 SAINT ROSE PKWY STE 120
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City | HENDERSON
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State | NV
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Zip | 89074-7770
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Country | US
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Telephone | 480-847-2998
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Fax | 720-367-5067
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Provider Business Mailing Address
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Address Line | 3753 HOWARD HUGHES PKWY STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89169-0952
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Country | US
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Telephone | 480-847-2998
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Fax | 720-367-5067
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL K CHISM II
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Credential | PMHNP
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Telephone | 303-587-8592
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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