Provider Demographics
NPI:1689919854
Name:LLM MAHALA CORPORATION, LLC
Entity Type:Organization
Organization Name:LLM MAHALA CORPORATION, LLC
Other - Org Name:MBRACE COUNSELING & BEHAVIORAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LO'RECE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEBANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-787-9227
Mailing Address - Street 1:3030 S JONES BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6793
Mailing Address - Country:US
Mailing Address - Phone:702-749-6926
Mailing Address - Fax:702-272-2011
Practice Address - Street 1:3030 S JONES BLVD STE 110
Practice Address - Street 2:STE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6793
Practice Address - Country:US
Practice Address - Phone:702-749-6926
Practice Address - Fax:702-272-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty