Provider Demographics
NPI:1114795069
Name:ENVISION BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:ENVISION BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:725-780-1468
Mailing Address - Street 1:3910 PECOS MCLEOD STE C100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4304
Mailing Address - Country:US
Mailing Address - Phone:725-780-1468
Mailing Address - Fax:702-358-0617
Practice Address - Street 1:3910 PECOS MCLEOD STE C100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4304
Practice Address - Country:US
Practice Address - Phone:725-780-1468
Practice Address - Fax:702-358-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health