Provider Demographics
NPI:1972272896
Name:PEAVINE COUNSELING LLC
Entity Type:Organization
Organization Name:PEAVINE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ULLA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:775-560-9623
Mailing Address - Street 1:7117 LAKELAND RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6027
Mailing Address - Country:US
Mailing Address - Phone:775-560-9623
Mailing Address - Fax:866-348-2644
Practice Address - Street 1:480 W BONANZA RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3227
Practice Address - Country:US
Practice Address - Phone:775-560-9623
Practice Address - Fax:866-348-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health