Provider Demographics
NPI:1972833721
Name:DIVINE FAMILY ASSISTANCE OF NEVADA
Entity Type:Organization
Organization Name:DIVINE FAMILY ASSISTANCE OF NEVADA
Other - Org Name:DFAN BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-348-7653
Mailing Address - Street 1:9021 VICTOR CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3274
Mailing Address - Country:US
Mailing Address - Phone:702-348-7653
Mailing Address - Fax:
Practice Address - Street 1:9021 VICTOR CREEK AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3274
Practice Address - Country:US
Practice Address - Phone:702-348-7653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty