Provider Demographics
NPI:1457806663
Name:BOYS TOWN NEVADA, INC.
Entity Type:Organization
Organization Name:BOYS TOWN NEVADA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ETZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-642-7070
Mailing Address - Street 1:6460 MEDICAL CENTER ST STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2420
Mailing Address - Country:US
Mailing Address - Phone:702-888-1340
Mailing Address - Fax:702-888-1342
Practice Address - Street 1:6460 MEDICAL CENTER ST STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2420
Practice Address - Country:US
Practice Address - Phone:702-642-7070
Practice Address - Fax:702-649-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty