Provider Demographics
NPI:1356733174
Name:TRIUMPHANT FAMILY SERVICES
Entity type:Organization
Organization Name:TRIUMPHANT FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-912-0600
Mailing Address - Street 1:6396 MCLEOD DR STE 6-8
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6396 MCLEOD DR STE 6-8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4428
Practice Address - Country:US
Practice Address - Phone:702-912-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1154756302Medicaid