Provider Demographics
NPI:1871090498
Name:NORTH LAS VEGAS BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:NORTH LAS VEGAS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-586-5999
Mailing Address - Street 1:3131 W CRAIG RD STE 180
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0861
Mailing Address - Country:US
Mailing Address - Phone:702-586-5999
Mailing Address - Fax:702-586-5991
Practice Address - Street 1:3131 W CRAIG RD STE 180
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-586-5999
Practice Address - Fax:702-586-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
NVNV20151645220261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1578935508Medicaid