Provider Demographics
NPI:1336506559
Name:BRIDGES YOUTH AND FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:BRIDGES YOUTH AND FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-321-9883
Mailing Address - Street 1:2350 S JONES BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3118
Mailing Address - Country:US
Mailing Address - Phone:702-215-5830
Mailing Address - Fax:702-215-5801
Practice Address - Street 1:2350 S JONES BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3118
Practice Address - Country:US
Practice Address - Phone:702-215-5830
Practice Address - Fax:702-215-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131717184251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health