Provider Demographics
NPI:1518017342
Name:PROVIDER PROFILES, INC.
Entity Type:Organization
Organization Name:PROVIDER PROFILES, INC.
Other - Org Name:COUNSELING CONNECTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:OMEGA
Authorized Official - Middle Name:JODEAN
Authorized Official - Last Name:GALLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:702-258-5711
Mailing Address - Street 1:8350 W SAHARA AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8939
Mailing Address - Country:US
Mailing Address - Phone:702-258-5711
Mailing Address - Fax:702-258-1304
Practice Address - Street 1:8350 W SAHARA AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8939
Practice Address - Country:US
Practice Address - Phone:702-258-5711
Practice Address - Fax:702-258-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty