Provider Demographics
NPI:1821698556
Name:THERAPY OF SOUTHERN NEVADA LLC
Entity Type:Organization
Organization Name:THERAPY OF SOUTHERN NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:702-268-7604
Mailing Address - Street 1:3340 TOPAZ ST STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3906
Mailing Address - Country:US
Mailing Address - Phone:702-268-7604
Mailing Address - Fax:702-442-8840
Practice Address - Street 1:3340 TOPAZ ST STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3906
Practice Address - Country:US
Practice Address - Phone:702-268-7604
Practice Address - Fax:702-442-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250011146Medicaid