Provider Demographics
NPI:1174815047
Name:B.D.D. COUNSELING LLC
Entity Type:Organization
Organization Name:B.D.D. COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAVATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LADC
Authorized Official - Phone:702-384-2960
Mailing Address - Street 1:3909 S MARYLAND PKWY STE 211
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7520
Mailing Address - Country:US
Mailing Address - Phone:702-384-2960
Mailing Address - Fax:702-384-2963
Practice Address - Street 1:3909 S MARYLAND PKWY STE 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7520
Practice Address - Country:US
Practice Address - Phone:702-384-2960
Practice Address - Fax:702-384-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health