1912333550 NPI number — TENAZCITY,PC

Table of content: (NPI 1912333550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912333550 NPI number — TENAZCITY,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENAZCITY,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TENAZCITY BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912333550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
259 CASCADING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89074-8720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-487-5550
Provider Business Mailing Address Fax Number:
702-446-8017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3930 E PATRICK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89120-4924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-487-5550
Provider Business Practice Location Address Fax Number:
702-446-8017
Provider Enumeration Date:
09/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WESTFIELD
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/DIRECTOR
Authorized Official Telephone Number:
702-373-1265

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X , with the licence number:  PY 0234 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PY 0234 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PY 0234 . This is a "PSYCHOLOGY LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com