Provider Demographics
NPI:1609692169
Name:SUMMERLIN SERENITY P.L.L.C.
Entity type:Organization
Organization Name:SUMMERLIN SERENITY P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW
Authorized Official - Phone:209-568-5346
Mailing Address - Street 1:8044 REDBUD VINE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89085-4455
Mailing Address - Country:US
Mailing Address - Phone:702-556-9891
Mailing Address - Fax:
Practice Address - Street 1:8044 REDBUD VINE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89085-4455
Practice Address - Country:US
Practice Address - Phone:702-556-9891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty