Provider Demographics
NPI:1972112944
Name:COUNSELING OFFICE OF YOUNTINA AMBIS LLC
Entity Type:Organization
Organization Name:COUNSELING OFFICE OF YOUNTINA AMBIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:YOUNTINA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:AMBIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC, BCN
Authorized Official - Phone:702-328-1986
Mailing Address - Street 1:4580 S EASTERN AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6100
Mailing Address - Country:US
Mailing Address - Phone:702-328-1986
Mailing Address - Fax:702-825-2598
Practice Address - Street 1:4580 S EASTERN AVE STE 33
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6100
Practice Address - Country:US
Practice Address - Phone:702-241-2472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility