Provider Demographics
NPI:1760763783
Name:YOUR CHOICE BEHAVIORIAL
Entity Type:Organization
Organization Name:YOUR CHOICE BEHAVIORIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-538-9474
Mailing Address - Street 1:3785 E SUNSET RD
Mailing Address - Street 2:STE. A - 10
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-6259
Mailing Address - Country:US
Mailing Address - Phone:702-538-9474
Mailing Address - Fax:
Practice Address - Street 1:3785 E SUNSET RD
Practice Address - Street 2:STE. A - 10
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-6259
Practice Address - Country:US
Practice Address - Phone:702-538-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2001065320322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children