Provider Demographics
NPI:1881038370
Name:PARK PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:PARK PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-685-0674
Mailing Address - Street 1:7345 S DURANGO DR
Mailing Address - Street 2:B107/220
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3653
Mailing Address - Country:US
Mailing Address - Phone:702-685-0674
Mailing Address - Fax:702-566-4575
Practice Address - Street 1:7345 S DURANGO DR
Practice Address - Street 2:B107/220
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3653
Practice Address - Country:US
Practice Address - Phone:702-685-0674
Practice Address - Fax:702-566-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO15682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty