Provider Demographics
NPI:1659625358
Name:TAKING BACK HOPE INC
Entity Type:Organization
Organization Name:TAKING BACK HOPE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT, LADC
Authorized Official - Phone:702-434-1564
Mailing Address - Street 1:1641 E FLAMINGO RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5257
Mailing Address - Country:US
Mailing Address - Phone:702-434-1564
Mailing Address - Fax:
Practice Address - Street 1:1641 E FLAMINGO RD
Practice Address - Street 2:SUITE 7
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5257
Practice Address - Country:US
Practice Address - Phone:702-434-1564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty