Provider Demographics
NPI:1174865331
Name:MARQUEZ FAMILY SERVICES
Entity Type:Organization
Organization Name:MARQUEZ FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT-INTERN
Authorized Official - Phone:702-472-3137
Mailing Address - Street 1:3652 N RANCHO DR
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3178
Mailing Address - Country:US
Mailing Address - Phone:702-472-3137
Mailing Address - Fax:
Practice Address - Street 1:7224 DIAMOND HOPE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-4403
Practice Address - Country:US
Practice Address - Phone:702-472-3137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVP50-03087-2-164460251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1015157114001Medicaid