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NPI Code Detail

MEDICARE: VR THERAPY LAS VEGAS, INC.

MEDICARE: VR THERAPY LAS VEGAS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health AgencyPY0790NV

General Provider Information

NPI Number : 1033669627
Entity Type Code : Organization
Provider Name (Legal Business Name) : VR THERAPY LAS VEGAS, INC.
Provider Business Mailing Address
First Line : 1489 W WARM SPRINGS RD STE 110
Second Line :
City : HENDERSON
State : NV
Zip : 89014-7367
Country : US
Telephone Number : 702-824-9639
Fax Number : 725-600-9938
Provider Business Practice Location Address
First Line : 2518 ANTHEM VILLAGE DR STE 103
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5554
Country : US
Telephone Number : 702-824-9639
Fax Number : 725-214-3420
Authorized Official
Title or Position : PRESIDENT
Name : DR. JEREMY GALLAS
Credential : PSY.D.
Telephone Number : 702-824-9639
Provider Enumeration Date : 10/07/2016
Last Update Date : 10/04/2024

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