Provider Demographics
NPI:1295368041
Name:FORWARD IMPRESSIONS, LLC
Entity type:Organization
Organization Name:FORWARD IMPRESSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-469-1597
Mailing Address - Street 1:3650 N RANCHO DR STE 109
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3151
Mailing Address - Country:US
Mailing Address - Phone:702-848-1411
Mailing Address - Fax:702-848-1711
Practice Address - Street 1:3650 N RANCHO DR STE 109
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3151
Practice Address - Country:US
Practice Address - Phone:702-848-1411
Practice Address - Fax:702-848-1711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORWARD IMPRESSIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-20
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty