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General NPI Number Information
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NPI Number | 1851027643
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Entity Type | Organization
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Legal Business Name | VIRGIN VALLEY MENTAL HEALTH LLC
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 736 W PIONEER BLVD STE 108
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City | MESQUITE
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State | NV
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Zip | 89027-8890
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Country | US
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Telephone | 702-807-3289
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Fax |
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Provider Business Mailing Address
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Address Line | 157 PEBBLE CREEK HTS
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City | MESQUITE
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State | NV
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Zip | 89027-5323
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Country | US
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Telephone | 702-807-3289
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID TAYLOR
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Credential | LCSW
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Telephone | 702-807-3289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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