Provider Demographics
NPI:1093147159
Name:INFINATE RA, LLC
Entity Type:Organization
Organization Name:INFINATE RA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAIN OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MCOUN
Authorized Official - Phone:702-938-8887
Mailing Address - Street 1:2441 TECH CENTER CT
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0804
Mailing Address - Country:US
Mailing Address - Phone:702-938-8887
Mailing Address - Fax:702-256-1805
Practice Address - Street 1:2441 TECH CENTER CT
Practice Address - Street 2:SUITE 107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0804
Practice Address - Country:US
Practice Address - Phone:702-938-8887
Practice Address - Fax:702-256-1805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFINITE RA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty