Provider Demographics
NPI:1659749786
Name:VON DIAGNOSTIC AND COUNSELING,LLC
Entity Type:Organization
Organization Name:VON DIAGNOSTIC AND COUNSELING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAVON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADC
Authorized Official - Phone:702-917-0367
Mailing Address - Street 1:5172 JEWEL CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-8328
Mailing Address - Country:US
Mailing Address - Phone:702-917-0367
Mailing Address - Fax:
Practice Address - Street 1:4560 S EASTERN AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6182
Practice Address - Country:US
Practice Address - Phone:702-613-7060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-06
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLADC 01322-L101YA0400X
NVLCSW 7031-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty