Provider Demographics
NPI:1740449347
Name:DIANE HERBS, PHD LLC
Entity type:Organization
Organization Name:DIANE HERBS, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGISTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-428-4083
Mailing Address - Street 1:4012 S RAINBOW BLVD # K484
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2010
Mailing Address - Country:US
Mailing Address - Phone:702-428-4083
Mailing Address - Fax:
Practice Address - Street 1:8870 S MARYLAND PKWY STE 125
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4010
Practice Address - Country:US
Practice Address - Phone:702-428-4083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0351103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002602030Medicaid
NV002602030Medicaid