Provider Demographics
NPI:1578910238
Name:HIGHER POTENTIAL FOR LEARNING
Entity Type:Organization
Organization Name:HIGHER POTENTIAL FOR LEARNING
Other - Org Name:IDEAL LIFE BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-528-1276
Mailing Address - Street 1:5773 LAZY DAYS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-0403
Mailing Address - Country:US
Mailing Address - Phone:702-528-1276
Mailing Address - Fax:
Practice Address - Street 1:5773 LAZY DAYS CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-0403
Practice Address - Country:US
Practice Address - Phone:702-528-1276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251300000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health