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General NPI Number Information
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NPI Number | 1972272896
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Entity Type | Organization
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Legal Business Name | PEAVINE COUNSELING LLC
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 480 W BONANZA RD
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City | LAS VEGAS
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State | NV
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Zip | 89106-3227
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Country | US
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Telephone | 775-560-9623
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Fax | 866-348-2644
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Provider Business Mailing Address
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Address Line | 7117 LAKELAND RD
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City | LAS VEGAS
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State | NV
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Zip | 89145-6027
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Country | US
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Telephone | 775-560-9623
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Fax | 866-348-2644
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ULLA YANDELL
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Credential | LCSW
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Telephone | 775-560-9623
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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