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NPI Code Detail

MEDICARE: NEVADA STATE TRIAGE CENTER

MEDICARE: NEVADA STATE TRIAGE CENTER
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3106S00000XBehavior Technician
4171M00000XCase Manager/Care Coordinator
5405300000XPrevention Professional
6207RA0401XAddiction Medicine (Internal Medicine) Physician
72084P0802XAddiction Psychiatry Physician
8276400000XSubstance Use Disorder Rehabilitation Hospital Unit
9324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1790267912
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEVADA STATE TRIAGE CENTER
Provider Business Mailing Address
First Line : 5530 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-0566
Country : US
Telephone Number : 702-909-3440
Fax Number :
Provider Business Practice Location Address
First Line : 5530 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-0566
Country : US
Telephone Number : 702-683-4498
Fax Number :
Authorized Official
Title or Position : CHIEF FINANCIAL OFFIER
Name : MR. CLIFFORD ETIENNE
Credential : B.S.
Telephone Number : 702-771-0304
Provider Enumeration Date : 09/04/2018
Last Update Date : 01/15/2019

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Directions to “NEVADA STATE TRIAGE CENTER ” Practice Location

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