Provider Demographics
NPI:1871734772
Name:MOBILE MENTAL HEALTH SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:MOBILE MENTAL HEALTH SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANITSHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRIDGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:702-556-1511
Mailing Address - Street 1:5348 HANGING TREE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2032
Mailing Address - Country:US
Mailing Address - Phone:702-556-1511
Mailing Address - Fax:
Practice Address - Street 1:5348 HANGING TREE LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2032
Practice Address - Country:US
Practice Address - Phone:702-556-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities