Provider Demographics
NPI:1790990349
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES NV LAS VEGAS AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-385-1072
Mailing Address - Street 1:4455 ALLEN LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2229
Mailing Address - Country:US
Mailing Address - Phone:702-385-1072
Mailing Address - Fax:702-385-3053
Practice Address - Street 1:4455 ALLEN LN
Practice Address - Street 2:SUITE 130
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2229
Practice Address - Country:US
Practice Address - Phone:702-385-1072
Practice Address - Fax:702-385-3053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4096-C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health