Provider Demographics
NPI:1093167009
Name:CASSIDY, JAMES J II (LADC, CPC INTERN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:CASSIDY
Suffix:II
Gender:M
Credentials:LADC, CPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 E SUNSET RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-7230
Mailing Address - Country:US
Mailing Address - Phone:702-932-4308
Mailing Address - Fax:702-837-8930
Practice Address - Street 1:3602 E SUNSET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-7230
Practice Address - Country:US
Practice Address - Phone:702-932-4308
Practice Address - Fax:702-837-8930
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01512-L101YA0400X
NVCI0216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional