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General NPI Number Information
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NPI Number | 1881048320
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Entity Type | Organization
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Legal Business Name | JIM GOINS
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 5420 W SAHARA AVE STE 102-6
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City | LAS VEGAS
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State | NV
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Zip | 89146-0394
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Country | US
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Telephone | 484-868-0584
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Fax |
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Provider Business Mailing Address
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Address Line | 5420 W SAHARA AVE STE 102-6
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City | LAS VEGAS
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State | NV
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Zip | 89146-0394
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Country | US
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Telephone | 484-868-0584
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | JIM GOINS
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Credential | LCPC
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Telephone | 484-868-0584
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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 | CP0128
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License Number State | NV
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