Provider Demographics
NPI:1790036309
Name:NOVA BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:NOVA BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:X
Authorized Official - Last Name:CONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1866-832-3015
Mailing Address - Street 1:PO BOX 51354
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435-1354
Mailing Address - Country:US
Mailing Address - Phone:866-832-3015
Mailing Address - Fax:775-737-4332
Practice Address - Street 1:4860 VISTA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-2863
Practice Address - Country:US
Practice Address - Phone:866-832-3015
Practice Address - Fax:775-737-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101103448251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health