Provider Demographics
NPI:1821552449
Name:HOPE MENTAL & BEHAVIORAL HEALTH SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:HOPE MENTAL & BEHAVIORAL HEALTH SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-488-4918
Mailing Address - Street 1:520 S CASINO CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6504
Mailing Address - Country:US
Mailing Address - Phone:702-785-2812
Mailing Address - Fax:
Practice Address - Street 1:520 S CASINO CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6504
Practice Address - Country:US
Practice Address - Phone:702-785-2812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20191064604Medicaid
NVNV20181868625Medicaid