Provider Demographics
NPI: | 1174847396 |
---|---|
Name: | FAMILY INSTITUTE OF NEVADA |
Entity Type: | Organization |
Organization Name: | FAMILY INSTITUTE OF NEVADA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | HERBERT |
Authorized Official - Last Name: | HARRISON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT, MDIV |
Authorized Official - Phone: | 702-629-7024 |
Mailing Address - Street 1: | 3663 E SUNSET RD |
Mailing Address - Street 2: | SUITE 104 |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89120-3218 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-629-7024 |
Mailing Address - Fax: | 702-794-4501 |
Practice Address - Street 1: | 3663 E SUNSET RD |
Practice Address - Street 2: | SUITE 104 |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89120-3218 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-794-0727 |
Practice Address - Fax: | 702-794-4501 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-03-17 |
Last Update Date: | 2010-03-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NV | 0612 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |