Provider Demographics
NPI:1467901363
Name:ACT COUNSELING CENTER & HENDERSON, PROF. LLC
Entity Type:Organization
Organization Name:ACT COUNSELING CENTER & HENDERSON, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-823-3085
Mailing Address - Street 1:5728 EMERALD VIEW ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1562
Mailing Address - Country:US
Mailing Address - Phone:702-823-3085
Mailing Address - Fax:702-823-3085
Practice Address - Street 1:5728 EMERALD VIEW ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-1562
Practice Address - Country:US
Practice Address - Phone:702-823-3085
Practice Address - Fax:702-823-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131070050251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health