Provider Demographics
NPI:1467019125
Name:SOUTHERN NEVADA PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SOUTHERN NEVADA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-483-8017
Mailing Address - Street 1:2770 S MARYLAND PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1564
Mailing Address - Country:US
Mailing Address - Phone:702-483-0817
Mailing Address - Fax:702-202-0923
Practice Address - Street 1:2770 S. MARYLAND PKWY STE. 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1568
Practice Address - Country:US
Practice Address - Phone:702-483-8017
Practice Address - Fax:702-202-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1467019125Medicaid