Basic Information
| Provider Information | |||||||||
| NPI: | 1598205635 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHANCES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3531 E RUSSELL RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891202245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027027185 | ||||||||
| FaxNumber: | 7024785266 | ||||||||
| Practice Location | |||||||||
| Address1: | 3531 E RUSSELL RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891202245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027027185 | ||||||||
| FaxNumber: | 7024785266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2017 | ||||||||
| LastUpdateDate: | 03/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | BRICE | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6027027185 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.