Provider Demographics
NPI:1326354309
Name:SERENITY COUNSELING AND SUPPORT SERVICES
Entity Type:Organization
Organization Name:SERENITY COUNSELING AND SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SOMMER
Authorized Official - Middle Name:THYME
Authorized Official - Last Name:BERGDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:702-376-0024
Mailing Address - Street 1:PO BOX 60561
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89006-0561
Mailing Address - Country:US
Mailing Address - Phone:702-376-0024
Mailing Address - Fax:702-479-7173
Practice Address - Street 1:578 REDRUTH DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-1282
Practice Address - Country:US
Practice Address - Phone:702-376-0024
Practice Address - Fax:702-479-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5554-C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health