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NPI Code Detail

MEDICARE: CANDLELIGHT MENTAL HEALTH COUNSELING CENTER LLC

MEDICARE: CANDLELIGHT MENTAL HEALTH COUNSELING CENTER LLC
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164089488
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANDLELIGHT MENTAL HEALTH COUNSELING CENTER LLC
Provider Business Mailing Address
First Line : 700 ROCKY TRAIL RD
Second Line :
City : HENDERSON
State : NV
Zip : 89014-0321
Country : US
Telephone Number : 702-738-9064
Fax Number :
Provider Business Practice Location Address
First Line : 5258 S EASTERN AVE STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2327
Country : US
Telephone Number : 702-464-5080
Fax Number :
Authorized Official
Title or Position : CEO
Name : SHIBA NEOMI AMEZCUA
Credential :
Telephone Number : 702-738-9064
Provider Enumeration Date : 05/22/2019
Last Update Date : 05/22/2019

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