Provider Demographics
NPI:1740696830
Name:GUEVARA PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:GUEVARA PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:702-212-3008
Mailing Address - Street 1:7221 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1580
Mailing Address - Country:US
Mailing Address - Phone:702-212-3008
Mailing Address - Fax:702-933-3064
Practice Address - Street 1:7221 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1580
Practice Address - Country:US
Practice Address - Phone:702-212-3008
Practice Address - Fax:702-933-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510273Medicaid