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General NPI Number Information
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NPI Number | 1952772345
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Entity Type | Organization
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Legal Business Name | VENCER HEALTH
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 4955 S DURANGO DR #207
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City | LAS VEGAS
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State | NV
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Zip | 89113-0152
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Country | US
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Telephone | 702-267-6277
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Fax |
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Provider Business Mailing Address
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Address Line | 4955 S DURANGO DR #207
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City | LAS VEGAS
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State | NV
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Zip | 89113-0152
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Country | US
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Telephone | 702-267-6277
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. TRACY A DAVIS
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Credential |
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Telephone | 702-267-6277
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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 | NV20151295293
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | NV20151295293
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | NV20151295293
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License Number State | NV
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