Provider Demographics
NPI:1740552264
Name:T3SL LLC
Entity type:Organization
Organization Name:T3SL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TOSHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-816-3658
Mailing Address - Street 1:7473 W LAKE MEAD BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0265
Mailing Address - Country:US
Mailing Address - Phone:702-816-3658
Mailing Address - Fax:702-816-4337
Practice Address - Street 1:2020 PINTO LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4019
Practice Address - Country:US
Practice Address - Phone:702-816-3658
Practice Address - Fax:702-816-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121040148251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health