Provider Demographics
NPI:1780217679
Name:58 10 BEHAVIORAL HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:58 10 BEHAVIORAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-286-5386
Mailing Address - Street 1:1810 E SAHARA AVE STE 212 373
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3707
Mailing Address - Country:US
Mailing Address - Phone:702-286-5386
Mailing Address - Fax:702-566-4575
Practice Address - Street 1:1810 E SAHARA AVE STE 212 373
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3707
Practice Address - Country:US
Practice Address - Phone:702-286-5386
Practice Address - Fax:702-566-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1275913030OtherNPI