Provider Demographics
NPI:1073857967
Name:COMMUNITY COUNSELING AND BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING AND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-497-7510
Mailing Address - Street 1:10809 NOBLE MESA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5107
Mailing Address - Country:US
Mailing Address - Phone:702-497-7510
Mailing Address - Fax:
Practice Address - Street 1:10809 NOBLE MESA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-5107
Practice Address - Country:US
Practice Address - Phone:702-497-7510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health