Provider Demographics
| NPI: | 1457742975 |
|---|---|
| Name: | NEVADA INTEGRATED BEHAVIORAL SERVICES INC. |
| Entity type: | Organization |
| Organization Name: | NEVADA INTEGRATED BEHAVIORAL SERVICES INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER/PRESIDENT |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | FESTUS |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | EBONKA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | NURSE PRACTITIONER |
| Authorized Official - Phone: | 702-515-9680 |
| Mailing Address - Street 1: | 1721 E CHARLESTON BLVD STE 310 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LAS VEGAS |
| Mailing Address - State: | NV |
| Mailing Address - Zip Code: | 89104-1902 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 702-515-9680 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1721 E CHARLESTON BLVD STE 310 |
| Practice Address - Street 2: | |
| Practice Address - City: | LAS VEGAS |
| Practice Address - State: | NV |
| Practice Address - Zip Code: | 89104-1902 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 702-685-0620 |
| Practice Address - Fax: | 702-685-9674 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | NEVADA INTEGRATED BEHAVIORAL SERVICES INC. |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2015-02-06 |
| Last Update Date: | 2025-04-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NV | NV20131553514 | 261QM2800X, 363L00000X, 101YA0400X, 101YM0800X, 103T00000X, 103TA0400X, 103TC0700X, 103TC2200X, 104100000X, 1041C0700X, 163W00000X, 164W00000X, 261QM0801X, 261QM0855X, 261QM0850X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
| No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Multi-Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
