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NPI Code Detail

MEDICARE: DESERT ROSE COUNSELING GROUP, LLC

MEDICARE: DESERT ROSE COUNSELING GROUP, 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
1251S00000XCommunity/Behavioral Health AgencyNV20131676117NV

General Provider Information

NPI Number : 1184054553
Entity Type Code : Organization
Provider Name (Legal Business Name) : DESERT ROSE COUNSELING GROUP, LLC
Provider Business Mailing Address
First Line : 4344 W CHEYENNE AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-2484
Country : US
Telephone Number : 702-715-1182
Fax Number : 702-543-5109
Provider Business Practice Location Address
First Line : 4344 W CHEYENNE AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-2484
Country : US
Telephone Number : 702-715-1182
Fax Number : 702-543-5109
Authorized Official
Title or Position : CEO
Name : MISS BIANCA MCCALL
Credential : MS MFT
Telephone Number : 702-715-1182
Provider Enumeration Date : 11/20/2013
Last Update Date : 06/18/2014

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