Provider Demographics
NPI:1629556261
Name:SELF SUFFICIENCY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:SELF SUFFICIENCY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/QMHA
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:LIZBETH
Authorized Official - Last Name:ORTIZ CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:702-704-9465
Mailing Address - Street 1:3965 E OWENS AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-7034
Mailing Address - Country:US
Mailing Address - Phone:702-331-5983
Mailing Address - Fax:
Practice Address - Street 1:3965 E OWENS AVE STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-7034
Practice Address - Country:US
Practice Address - Phone:702-331-5983
Practice Address - Fax:702-268-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health