Provider Demographics
NPI:1639489149
Name:FAITH IN LIFE COUNSELING CENTER
Entity Type:Organization
Organization Name:FAITH IN LIFE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MCMANIGELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSEDCPC
Authorized Official - Phone:702-496-6054
Mailing Address - Street 1:3663 E. SUNSET RD. STE. 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120
Mailing Address - Country:US
Mailing Address - Phone:702-496-6054
Mailing Address - Fax:
Practice Address - Street 1:3663 E SUNSET RD STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3246
Practice Address - Country:US
Practice Address - Phone:702-496-6054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0028251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health