Basic Information
Provider Information
NPI: 1073892980
EntityType: 2
ReplacementNPI:  
OrganizationName: NEVADA IMPROVEMENT PROJECT
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2820 S JONES BLVD STE 1
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891465650
CountryCode: US
TelephoneNumber: 7028880036
FaxNumber: 7028880035
Practice Location
Address1: 2820 S JONES BLVD STE 1
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891465650
CountryCode: US
TelephoneNumber: 7028880036
FaxNumber: 7028880035
Other Information
ProviderEnumerationDate: 08/09/2011
LastUpdateDate: 08/09/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BRIDGERS
AuthorizedOfficialFirstName: TANITSHA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: EXECUTIVE DIRECTOR
AuthorizedOfficialTelephone: 7028880036
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: LCSW
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251V00000X  Y AgenciesVoluntary or Charitable 

No ID Information.


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