Provider Demographics
NPI:1235513631
Name:SP COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:SP COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-629-6340
Mailing Address - Street 1:6767 W CHARLESTON BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-9004
Mailing Address - Country:US
Mailing Address - Phone:702-629-6340
Mailing Address - Fax:702-629-7928
Practice Address - Street 1:40 E CENTER ST
Practice Address - Street 2:UNIT #12
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3475
Practice Address - Country:US
Practice Address - Phone:775-867-5615
Practice Address - Fax:775-867-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151423195251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health