Basic Information
| Provider Information | |||||||||
| NPI: | 1205407178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANTAGE BEHAVIORAL HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2625 S RAINBOW BLVD STE C102 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024037999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2625 S RAINBOW BLVD STE C102 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024037999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2021 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | AMATO VON HEMERT | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MENBER | ||||||||
| AuthorizedOfficialTelephone: | 7028352396 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106S00000X | N | 193200000X MULTI-SPECIALTY GROUP | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106E00000X | N | 193200000X MULTI-SPECIALTY GROUP | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.