Provider Demographics
NPI:1710504170
Name:GUAVA PSYCHOLOGICAL CENTRE LLC
Entity Type:Organization
Organization Name:GUAVA PSYCHOLOGICAL CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:STRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-368-3599
Mailing Address - Street 1:8440 W LAKE MEAD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7648
Mailing Address - Country:US
Mailing Address - Phone:702-368-3599
Mailing Address - Fax:
Practice Address - Street 1:8440 W LAKE MEAD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7648
Practice Address - Country:US
Practice Address - Phone:702-368-3599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty