Provider Demographics
NPI:1720376510
Name:MOBILE MENTAL HEALTH SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:MOBILE MENTAL HEALTH SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANITSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-556-1511
Mailing Address - Street 1:3085 S JONES BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6767
Mailing Address - Country:US
Mailing Address - Phone:702-888-0036
Mailing Address - Fax:702-888-0035
Practice Address - Street 1:3085 S JONES BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6767
Practice Address - Country:US
Practice Address - Phone:702-888-0036
Practice Address - Fax:702-888-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health