MEDICARE: PHC OF NEVADA 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
1	106H00000X	Marriage & Family Therapist
2	104100000X	Social Worker
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	1041C0700X	Clinical Social Worker
5	363AM0700X	Medical Physician Assistant
6	2084P0802X	Addiction Psychiatry Physician
7	101Y00000X	Counselor
8	2084P0800X	Psychiatry Physician
9	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
10	101YM0800X	Mental Health Counselor	6928	NV

General Provider Information

NPI Number	:	1326187782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHC OF NEVADA INC

Provider Business Mailing Address
First Line	:	1701 W CHARLESTON BLVD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2313
Country	:	US
Telephone Number	:	702-251-8000
Fax Number	:	702-380-6925

Provider Business Practice Location Address
First Line	:	1701 W CHARLESTON BLVD
Second Line	:	SUITE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2325
Country	:	US
Telephone Number	:	702-251-8000
Fax Number	:	702-380-6925

Authorized Official
Title or Position	:	DIRECTOR ADMINISTRATIVE SERVICES
Name	:	ANNETTA KATHLEEN DESBOUILLONS
Credential	:
Telephone Number	:	702-404-2213

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	03/11/2026

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Directions to “PHC OF NEVADA INC ” Practice Location

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