Provider Demographics
NPI:1811436959
Name:ALOHA BEHAVIORAL CLINICAL SERVICES
Entity type:Organization
Organization Name:ALOHA BEHAVIORAL CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC, CPGC
Authorized Official - Phone:702-412-8405
Mailing Address - Street 1:9840 WILD COYOTE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8746
Mailing Address - Country:US
Mailing Address - Phone:702-412-8405
Mailing Address - Fax:
Practice Address - Street 1:9840 WILD COYOTE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-8746
Practice Address - Country:US
Practice Address - Phone:702-412-8405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20171108675251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health