Provider Demographics
NPI:1427550599
Name:AREVALO COUNSELING & MENTORING, LLC
Entity Type:Organization
Organization Name:AREVALO COUNSELING & MENTORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOUNEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AREVALO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:702-809-9185
Mailing Address - Street 1:8306 TIME MACHINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6165
Mailing Address - Country:US
Mailing Address - Phone:702-970-3535
Mailing Address - Fax:702-441-0915
Practice Address - Street 1:1070 W HORIZON RIDGE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-6020
Practice Address - Country:US
Practice Address - Phone:702-970-3535
Practice Address - Fax:702-441-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1033305412Medicaid