Provider Demographics
NPI:1851027643
Name:VIRGIN VALLEY MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:VIRGIN VALLEY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-807-3289
Mailing Address - Street 1:157 PEBBLE CREEK HTS
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-5323
Mailing Address - Country:US
Mailing Address - Phone:702-807-3289
Mailing Address - Fax:
Practice Address - Street 1:736 W PIONEER BLVD STE 108
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8890
Practice Address - Country:US
Practice Address - Phone:702-807-3289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1881903581Medicaid