Provider Demographics
NPI:1487016887
Name:WALKBYFAITH LLC
Entity Type:Organization
Organization Name:WALKBYFAITH LLC
Other - Org Name:RESOLUTIONS BEHAVIORAL HEALTH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:BLANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-462-1813
Mailing Address - Street 1:6655 W SAHARA AVE STE A112
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2805
Mailing Address - Country:US
Mailing Address - Phone:702-462-1813
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE STE A112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2805
Practice Address - Country:US
Practice Address - Phone:702-462-1813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NV711-C251S00000X, 273R00000X, 305R00000X, 3104A0625X, 320800000X, 347C00000X, 261QM0850X
NV7112-C324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No273R00000XHospital UnitsPsychiatric Unit
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1487016887OtherTRICARE WEST
NV1487016887Medicaid