Basic Information
| Provider Information | |||||||||
| NPI: | 1619418928 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR BEHAVIORAL HEALTH LAS VEGAS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 SPRING VALLEY ROAD | ||||||||
| Address2: | SUITE 600 EAST | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752440897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143656100 | ||||||||
| FaxNumber: | 2143656150 | ||||||||
| Practice Location | |||||||||
| Address1: | 2290 MCDANIEL ST STE 1C | ||||||||
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| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890306329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023991600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | HIGHAM | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2143656100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | 7693NTC-1 | NV | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.