Provider Demographics
NPI:1447962071
Name:COLLABORATION CENTER FOUNDATION
Entity type:Organization
Organization Name:COLLABORATION CENTER FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-217-4194
Mailing Address - Street 1:8390 W WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4420
Mailing Address - Country:US
Mailing Address - Phone:702-329-3208
Mailing Address - Fax:
Practice Address - Street 1:8390 W WINDMILL LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4420
Practice Address - Country:US
Practice Address - Phone:702-329-3208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty