Provider Demographics
NPI:1972934255
Name:THERAPY MANAGEMENT GROUP
Entity Type:Organization
Organization Name:THERAPY MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-556-3132
Mailing Address - Street 1:6600 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-9001
Mailing Address - Country:US
Mailing Address - Phone:702-595-5437
Mailing Address - Fax:702-425-2787
Practice Address - Street 1:6600 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9001
Practice Address - Country:US
Practice Address - Phone:702-595-5437
Practice Address - Fax:702-425-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1-13-12787103K00000X
NV145542080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502120Medicaid