Provider Demographics
NPI:1508301730
Name:HINA'S ODYSSEY, LLC
Entity Type:Organization
Organization Name:HINA'S ODYSSEY, LLC
Other - Org Name:HINA'S ODYSSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-475-4754
Mailing Address - Street 1:4132 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 149
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3106
Mailing Address - Country:US
Mailing Address - Phone:775-475-4754
Mailing Address - Fax:775-403-1795
Practice Address - Street 1:4132 S RAINBOW BLVD
Practice Address - Street 2:SUITE 149
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3106
Practice Address - Country:US
Practice Address - Phone:775-475-4754
Practice Address - Fax:775-403-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-25
Last Update Date:2016-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141711940251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health