Provider Demographics
NPI:1477928356
Name:DYNAMIC FAMILY THERAPIES
Entity Type:Organization
Organization Name:DYNAMIC FAMILY THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-410-8400
Mailing Address - Street 1:2110 E FLAMINGO RD STE 317
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5193
Mailing Address - Country:US
Mailing Address - Phone:702-410-8400
Mailing Address - Fax:702-410-8401
Practice Address - Street 1:2110 E FLAMINGO RD STE 317
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5193
Practice Address - Country:US
Practice Address - Phone:702-410-8400
Practice Address - Fax:702-410-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services