Provider Demographics
NPI:1639733579
Name:CLARK COUNTY BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:CLARK COUNTY BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:MEILAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAGUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-815-6350
Mailing Address - Street 1:2375 E TROPICANA AVE STE 144
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6564
Mailing Address - Country:US
Mailing Address - Phone:702-244-0665
Mailing Address - Fax:
Practice Address - Street 1:4440 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7825
Practice Address - Country:US
Practice Address - Phone:702-444-0599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Single Specialty