Provider Demographics
NPI:1922494830
Name:IT'S OK 2 B DIFFERENT
Entity Type:Organization
Organization Name:IT'S OK 2 B DIFFERENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:RANE
Authorized Official - Last Name:BURSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-980-9050
Mailing Address - Street 1:2007 RAIN STORM CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-4857
Mailing Address - Country:US
Mailing Address - Phone:702-980-9050
Mailing Address - Fax:
Practice Address - Street 1:2007 RAIN STORM CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-4857
Practice Address - Country:US
Practice Address - Phone:702-980-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health