Provider Demographics
NPI:1275311789
Name:MOBILE CRISIS UNIT PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MOBILE CRISIS UNIT PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRUEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-419-0595
Mailing Address - Street 1:2340 PASEO DEL PRADO STE D303
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4342
Mailing Address - Country:US
Mailing Address - Phone:702-419-0595
Mailing Address - Fax:
Practice Address - Street 1:530 W 27TH ST STE 515B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3203
Practice Address - Country:US
Practice Address - Phone:702-419-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health