Provider Demographics
NPI:1447736012
Name:STEPPING OUT ON FAITH BH
Entity Type:Organization
Organization Name:STEPPING OUT ON FAITH BH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEY-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-278-0340
Mailing Address - Street 1:4710 LUXOR WAY APT 2219
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3023
Mailing Address - Country:US
Mailing Address - Phone:702-278-0340
Mailing Address - Fax:
Practice Address - Street 1:5901 N GRAND CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1405
Practice Address - Country:US
Practice Address - Phone:702-542-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV82-3082387251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health