Provider Demographics
NPI:1407110505
Name:SISTER 2 SISTER CONNECTION BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SISTER 2 SISTER CONNECTION BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:WARRENETTE
Authorized Official - Last Name:GALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-884-6781
Mailing Address - Street 1:700 LOLA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-5650
Mailing Address - Country:US
Mailing Address - Phone:702-884-6781
Mailing Address - Fax:702-651-1948
Practice Address - Street 1:700 LOLA AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5650
Practice Address - Country:US
Practice Address - Phone:702-884-6781
Practice Address - Fax:702-651-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health