Provider Demographics
NPI:1134836745
Name:SIMPLE LIFE FAVOR
Entity type:Organization
Organization Name:SIMPLE LIFE FAVOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:702-810-9226
Mailing Address - Street 1:7250 S DURANGO DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2255
Mailing Address - Country:US
Mailing Address - Phone:028-109-2267
Mailing Address - Fax:
Practice Address - Street 1:420 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2658
Practice Address - Country:US
Practice Address - Phone:702-810-9226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20201734239Medicaid