Provider Demographics
NPI:1437385408
Name:CIRCLE OF CHANGE ADOLESCENT BEHAVIORAL HEALTH COUNSELING CENTER
Entity Type:Organization
Organization Name:CIRCLE OF CHANGE ADOLESCENT BEHAVIORAL HEALTH COUNSELING CENTER
Other - Org Name:CIRCLE OF CHANGE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NASEATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, LADC
Authorized Official - Phone:702-479-1629
Mailing Address - Street 1:5516 S FORT APACHE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7679
Mailing Address - Country:US
Mailing Address - Phone:702-479-1629
Mailing Address - Fax:
Practice Address - Street 1:5516 S FORT APACHE RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7679
Practice Address - Country:US
Practice Address - Phone:702-479-1629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01201-L101YA0400X
NV4785-C1041C0700X
NV01010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty