Provider Demographics
NPI:1245772813
Name:HEBRON BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:HEBRON BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC, MAC IAADC
Authorized Official - Phone:855-432-7662
Mailing Address - Street 1:848 N RAINBOW BLVD
Mailing Address - Street 2:UNIT 2063
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1103
Mailing Address - Country:US
Mailing Address - Phone:855-432-7662
Mailing Address - Fax:888-812-4428
Practice Address - Street 1:1600 E DESERT INN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2525
Practice Address - Country:US
Practice Address - Phone:855-432-7662
Practice Address - Fax:888-812-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health