Basic Information
| Provider Information | |||||||||
| NPI: | 1871734772 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILE MENTAL HEALTH SUPPORT SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5348 HANGING TREE LN | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891182032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025561511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5348 HANGING TREE LN | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891182032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025561511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2009 | ||||||||
| LastUpdateDate: | 03/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | BRIDGERS | ||||||||
| AuthorizedOfficialFirstName: | TANITSHA | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7025561511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320700000X | NV | Y | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities |
No ID Information.