Provider Demographics
NPI:1144506650
Name:OUNCE OF PREVENTION BEHAVIOR SERVICES LLC
Entity type:Organization
Organization Name:OUNCE OF PREVENTION BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECCUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:ARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:702-354-0017
Mailing Address - Street 1:7495 W AZURE DR STE 256
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-4416
Mailing Address - Country:US
Mailing Address - Phone:702-354-0017
Mailing Address - Fax:
Practice Address - Street 1:7495 W AZURE DR STE 256
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4416
Practice Address - Country:US
Practice Address - Phone:702-354-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20111675665251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20111675665Medicaid