Provider Demographics
NPI:1356766497
Name:LV PSYCHIATRIC CARE
Entity type:Organization
Organization Name:LV PSYCHIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LOWRY
Authorized Official - Last Name:HAVILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-492-9439
Mailing Address - Street 1:2654 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE. B5-287
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-492-9439
Mailing Address - Fax:702-492-9537
Practice Address - Street 1:8872 S EASTERN AVE
Practice Address - Street 2:STE. 250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123
Practice Address - Country:US
Practice Address - Phone:702-492-9439
Practice Address - Fax:702-492-9537
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LV PSYCHIATRIC CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV137592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG0666ZMedicare PIN