Basic Information
| Provider Information | |||||||||
| NPI: | 1164660163 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLIANCE FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3435 W CRAIG RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890325115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027500377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3435 W CRAIG RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890325115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027500377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2009 | ||||||||
| LastUpdateDate: | 01/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | O'HARTZ | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
| AuthorizedOfficialMiddleName: | CHUCKALINE | ||||||||
| AuthorizedOfficialTitleorPosition: | QMHP | ||||||||
| AuthorizedOfficialTelephone: | 7027500377 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 5495C | NV | Y | Agencies | Community/Behavioral Health |
No ID Information.