Basic Information
| Provider Information | |||||||||
| NPI: | 1326331992 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NO CHILD LEFT BEHIND | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MALAYLA INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 ROBERTA LN | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894316802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753316252 | ||||||||
| FaxNumber: | 7753316250 | ||||||||
| Practice Location | |||||||||
| Address1: | 895 ROBERTA LN | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894316802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753316252 | ||||||||
| FaxNumber: | 7753316250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2011 | ||||||||
| LastUpdateDate: | 05/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | TOLBERT | ||||||||
| AuthorizedOfficialFirstName: | CANDIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7753316252 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | NV20101069786 | NV | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.