Provider Demographics
NPI:1972946804
Name:AGAPE BEHAVIORAL CENTER
Entity Type:Organization
Organization Name:AGAPE BEHAVIORAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BASIC SKILLS TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:AVEEON
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-372-8641
Mailing Address - Street 1:3985 E CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3212
Mailing Address - Country:US
Mailing Address - Phone:702-372-8641
Mailing Address - Fax:
Practice Address - Street 1:3620 N RANCHO DR
Practice Address - Street 2:STE. 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3155
Practice Address - Country:US
Practice Address - Phone:702-656-5683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty