Provider Demographics
NPI:1114638517
Name:CHILDREN AND ADOLESCENT MENTORING SERVICES
Entity Type:Organization
Organization Name:CHILDREN AND ADOLESCENT MENTORING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:JACKSON-HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-285-4051
Mailing Address - Street 1:PO BOX 33096
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3096
Mailing Address - Country:US
Mailing Address - Phone:702-285-4051
Mailing Address - Fax:888-725-8902
Practice Address - Street 1:8275 S EASTERN AVE STE 119
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2544
Practice Address - Country:US
Practice Address - Phone:702-285-4051
Practice Address - Fax:888-725-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health