Provider Demographics
NPI:1518473032
Name:GOLD CLINICAL SERVICES LLC
Entity Type:Organization
Organization Name:GOLD CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:CMBS
Authorized Official - Phone:702-268-5067
Mailing Address - Street 1:3885 S DECATUR BLVD STE 3010
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6814
Mailing Address - Country:US
Mailing Address - Phone:702-875-6618
Mailing Address - Fax:702-566-4575
Practice Address - Street 1:3885 S DECATUR BLVD STE 3010
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6814
Practice Address - Country:US
Practice Address - Phone:702-875-6618
Practice Address - Fax:702-875-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6823C1041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty