Provider Demographics
NPI:1962825026
Name:HEALTHY LIVING BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:HEALTHY LIVING BEHAVIORAL HEALTH SERVICES
Other - Org Name:HEALTHY LIVING FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LACOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-234-9339
Mailing Address - Street 1:284C E. LAKE MEAD PARKWAY
Mailing Address - Street 2:PMB#412
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015
Mailing Address - Country:US
Mailing Address - Phone:702-234-9339
Mailing Address - Fax:
Practice Address - Street 1:284C E LAKE MEAD PKWY
Practice Address - Street 2:PMB# 412
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5511
Practice Address - Country:US
Practice Address - Phone:702-234-9339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131745092251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health