Provider Demographics
NPI:1790339356
Name:DAWN STARKS-BALL DBA NEW LIFE THERAPY
Entity Type:Organization
Organization Name:DAWN STARKS-BALL DBA NEW LIFE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSHCA
Authorized Official - Phone:702-528-9947
Mailing Address - Street 1:5135 CAMINO AL NORTE STE 264
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2419
Mailing Address - Country:US
Mailing Address - Phone:702-853-6731
Mailing Address - Fax:720-247-1226
Practice Address - Street 1:5135 CAMINO AL NORTE STE 264
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2419
Practice Address - Country:US
Practice Address - Phone:702-853-6731
Practice Address - Fax:720-247-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty