Provider Demographics
NPI:1033347745
Name:TALON PEAK YOUTH AND FAMILY COUNSELING
Entity Type:Organization
Organization Name:TALON PEAK YOUTH AND FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-375-1488
Mailing Address - Street 1:4612 EVAN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-1624
Mailing Address - Country:US
Mailing Address - Phone:702-375-1488
Mailing Address - Fax:702-396-4193
Practice Address - Street 1:7381 PRAIRIE FALCON RD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0811
Practice Address - Country:US
Practice Address - Phone:702-375-1488
Practice Address - Fax:702-396-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty