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NPI Code Detail

MEDICARE: BOYS TOWN NEVADA, INC.

MEDICARE: BOYS TOWN 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
1101Y00000XCounselor
2103T00000XPsychologist

General Provider Information

NPI Number : 1457806663
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOYS TOWN NEVADA, INC.
Provider Business Mailing Address
First Line : 8390 W WINDMILL LN STE 102&103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4420
Country : US
Telephone Number : 702-888-1340
Fax Number : 702-888-1342
Provider Business Practice Location Address
First Line : 6460 MEDICAL CENTER ST STE 140
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2420
Country : US
Telephone Number : 702-642-7070
Fax Number : 702-649-3906
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : JOHN ETZELL
Credential :
Telephone Number : 702-642-7070
Provider Enumeration Date : 08/17/2016
Last Update Date : 05/14/2026

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Directions to “BOYS TOWN NEVADA, INC. ” Practice Location

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