Provider Demographics
NPI:1275030777
Name:VALLEY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:VALLEY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LCADC
Authorized Official - Phone:702-606-2230
Mailing Address - Street 1:3230 S BUFFALO DR STE 107
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2506
Mailing Address - Country:US
Mailing Address - Phone:702-606-2230
Mailing Address - Fax:702-606-2230
Practice Address - Street 1:3230 S BUFFALO DR STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2506
Practice Address - Country:US
Practice Address - Phone:702-606-2230
Practice Address - Fax:702-606-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty