Provider Demographics
NPI:1205594157
Name:LIFE TRANSITIONS MENTAL HEALTH
Entity type:Organization
Organization Name:LIFE TRANSITIONS MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:EMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-231-4493
Mailing Address - Street 1:3305 SPRING MOUNTAIN RD STE 107
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3305 SPRING MOUNTAIN RD STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8628
Practice Address - Country:US
Practice Address - Phone:725-231-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services