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General NPI Number Information
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NPI Number | 1992411771
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Entity Type | Organization
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Legal Business Name | XEN MENTAL HEALTH LLC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 4570 S EASTERN AVE # C27
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City | LAS VEGAS
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State | NV
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Zip | 89119-6183
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Country | US
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Telephone | 702-328-6286
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Fax |
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Provider Business Mailing Address
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Address Line | 10741 NOBLE MESA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89166-5106
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Country | US
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Telephone | 702-328-6286
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KATIE M SHIELDS
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Credential |
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Telephone | 702-328-6286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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