Provider Demographics
NPI:1356818066
Name:LIFE LAUNCH CENTERS OF NEVADA
Entity Type:Organization
Organization Name:LIFE LAUNCH CENTERS OF NEVADA
Other - Org Name:LIFE LAUNCH CENTERS OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FINANCIAL
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCHES
Authorized Official - Suffix:
Authorized Official - Credentials:IOP MENTAL HEALTH
Authorized Official - Phone:435-767-0552
Mailing Address - Street 1:315 W HILTON DR # 3-4
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2319
Mailing Address - Country:US
Mailing Address - Phone:435-767-0552
Mailing Address - Fax:435-767-0278
Practice Address - Street 1:3037 E WARM SPRINGS RD STE 400
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3759
Practice Address - Country:US
Practice Address - Phone:833-803-3883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherIOP MENTAL HEALTH