Provider Demographics
NPI:1902204225
Name:BEHAVIORAL HEALTH SERVICES OF CLARK COUNTY
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH SERVICES OF CLARK COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:II
Authorized Official - Credentials:BS
Authorized Official - Phone:702-830-6501
Mailing Address - Street 1:27 E. AGATE #309
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123
Mailing Address - Country:US
Mailing Address - Phone:702-830-6501
Mailing Address - Fax:
Practice Address - Street 1:27 E. AGATE #309
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123
Practice Address - Country:US
Practice Address - Phone:702-830-6501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141625823251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health