Provider Demographics
NPI:1326362930
Name:XL BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:XL BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:XL BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMEBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-780-9117
Mailing Address - Street 1:7471 PROUD MEADOWS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2340
Mailing Address - Country:US
Mailing Address - Phone:702-510-3352
Mailing Address - Fax:
Practice Address - Street 1:2030 E FLAMINGO RD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0831
Practice Address - Country:US
Practice Address - Phone:702-510-3352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5316-C251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health