Provider Demographics
NPI:1083919328
Name:DIVERSIFIED COALITION LLC
Entity Type:Organization
Organization Name:DIVERSIFIED COALITION LLC
Other - Org Name:DIVERSIFIED FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:PILI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-569-4455
Mailing Address - Street 1:2340 PASEO DEL PRADO
Mailing Address - Street 2:BUILDING D SUITE 206
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4360
Mailing Address - Country:US
Mailing Address - Phone:702-485-2121
Mailing Address - Fax:
Practice Address - Street 1:2340 PASEO DEL PRADO
Practice Address - Street 2:BUILDING D SUITE 206
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4360
Practice Address - Country:US
Practice Address - Phone:702-485-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVERSIFIED COALITION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty