Provider Demographics
NPI:1255824470
Name:PUSHING TROUGH COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PUSHING TROUGH COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-279-7503
Mailing Address - Street 1:6716 LAVENDER LILLY LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3302
Mailing Address - Country:US
Mailing Address - Phone:702-279-7503
Mailing Address - Fax:
Practice Address - Street 1:2812 N NORWALK STE 127
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1148
Practice Address - Country:US
Practice Address - Phone:702-279-7503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty