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General NPI Number Information
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NPI Number | 1831626662
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Entity Type | Organization
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Legal Business Name | EVER EVOLVING COUNSELING CENER LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 5135 CAMINO AL NORTE
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City | N LAS VEGAS
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State | NV
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Zip | 89031-2387
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Country | US
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Telephone | 702-329-1716
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Fax |
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Provider Business Mailing Address
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Address Line | 5135 CAMINO AL NORTE
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City | N LAS VEGAS
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State | NV
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Zip | 89031-2387
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Country | US
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Telephone | 702-329-1716
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JUDYE REANEZE MARSHALL
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Credential | LADC
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Telephone | 702-523-8106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LADC 1273
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License Number State | NV
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