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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
1103T00000XPsychologist

General Provider Information

NPI Number : 1720670573
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOYS TOWN NEVADA, INC.
Provider Business Mailing Address
First Line : 6460 MEDICAL CENTER ST STE 140
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2420
Country : US
Telephone Number : 702-888-1340
Fax Number :
Provider Business Practice Location Address
First Line : 8390 W WINDMILL LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4420
Country : US
Telephone Number : 702-329-3208
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : JOHN ETZELL
Credential :
Telephone Number : 702-724-8402
Provider Enumeration Date : 02/03/2021
Last Update Date : 03/13/2023

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