Provider Demographics
NPI:1740810092
Name:EXECUTIVE THERAPY SOLUTIONS
Entity type:Organization
Organization Name:EXECUTIVE THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAICHART
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-635-6800
Mailing Address - Street 1:2620 REGATTA DRIVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-635-6800
Mailing Address - Fax:702-869-8844
Practice Address - Street 1:6887A W. CHARLESTON BLVD.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-635-6800
Practice Address - Fax:702-869-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty