Provider Demographics
NPI:1679903256
Name:SUPPORTIVE AND BEHAVIORAL COUNSELING OF LAS VEGAS, LLC
Entity Type:Organization
Organization Name:SUPPORTIVE AND BEHAVIORAL COUNSELING OF LAS VEGAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:209-596-6339
Mailing Address - Street 1:1650 E SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3494
Mailing Address - Country:US
Mailing Address - Phone:702-917-2705
Mailing Address - Fax:775-372-6126
Practice Address - Street 1:1650 E SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3494
Practice Address - Country:US
Practice Address - Phone:702-917-2705
Practice Address - Fax:775-372-6126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty