Provider Demographics
NPI:1407105778
Name:SHAINKER BEHAVIORAL THERAPY
Entity Type:Organization
Organization Name:SHAINKER BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAINKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-810-8400
Mailing Address - Street 1:2698 KINGHORN PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-8793
Mailing Address - Country:US
Mailing Address - Phone:702-810-8400
Mailing Address - Fax:702-818-5639
Practice Address - Street 1:7473 W LAKE MEAD BLVD
Practice Address - Street 2:SUITE # 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0265
Practice Address - Country:US
Practice Address - Phone:702-810-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-02
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6097-C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health