Provider Demographics
NPI:1619473949
Name:EASY ACCESS CLINIC LLC
Entity Type:Organization
Organization Name:EASY ACCESS CLINIC LLC
Other - Org Name:EASY ACCESS CLINIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-489-0920
Mailing Address - Street 1:6396 MCLEOD DR STE 9
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4429
Mailing Address - Country:US
Mailing Address - Phone:702-998-4465
Mailing Address - Fax:702-998-4471
Practice Address - Street 1:6396 MCLEOD DR STE 9
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4429
Practice Address - Country:US
Practice Address - Phone:702-998-4465
Practice Address - Fax:702-998-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV285985625OtherSS NUMBER